液体平衡与死亡率.pptVIP

Fluid Balance, Diuretic Use, and Mortality in Acute Kidney Injury Morgan E. Grams,*? Michelle M. Estrella,* Josef Coresh,*??, Roy G. Brower,* and Kathleen D. Liu§ for the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network Background and objectives Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients. Optimal fluid management in acute kidney injury (AKI) is controversial. Traditionally, aggressive fluid resuscitation has been prescribed in AKI to avoid additional prerenal or hemodynamic insults during ongoing renal dysfunction More recently, however, observational studies have demonstrated an association between a positive fluid balance, renal nonrecovery,and mortality in children and adults with AKI. Design, setting, participants, measurements Using data from the Fluid and Catheter Treatment Trial (FACTT), a multicenter, randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury (ALI), we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI, as defined by the AKI Network criteria. The Fluid and Catheter Treatment Trial (FACTT) was the largest and only multicenter trial of a fluid-restrictive management strategy for the treatment of acute lung injury (ALI) . Although there was no demonstrated mortality benefit, the fluid-restrictive management strategy was associated with an increased number of ventilator-free days and a trend toward a reduced requirement for renal replacement therapy. Results 306 patients developed AKI in the first 2 study days and were included in our analysis. There were 137 in the fluid-liberal arm and 169 in the fluid-conserv