Cerrahi Yoğun Bakım Hastalarında İntraoperatif ve Postoperatif Sıvı Dengesi: Hangisi Daha Önemli?

Öz

Amaç: Perioperatif sıvı yönetimi, cerrahi bakımın temel bir bileşenidir. Ancak intraoperatif ve postoperatif sıvı dengesinin yoğun bakım ünitesi (YBÜ) sonuçları üzerindeki göreceli etkisi net değildir. Bu çalışmanın amacı, elektif cerrahi geçiren hastalarda intraoperatif, postoperatif ve toplam perioperatif sıvı dengesinin temel YBÜ sonuçları üzerindeki etkisini değerlendirmektir. Materyal ve metod: Bu retrospektif gözlemsel çalışmaya, 1 Ocak-31 Aralık 2024 tarihleri arasında elektif cerrahi sonrası entübe şekilde YBÜ’ye kabul edilen 570 erişkin hasta dâhil edildi. Sıvı dengesi, vücut ağırlığının yüzdesi olarak hesaplandı ve üç zaman dilimi için (intraoperatif, postoperatif, toplam perioperatif) ≥%5 olanlar pozitif, <%5 olanlar negatif-normal olarak sınıflandırıldı. YBÜ sonuçları; mekanik ventilasyon süresi, YBÜ kalış süresi ve YBÜ mortalitesi olarak belirlendi. Tek değişkenli regresyon analizlerinin ardından, mortalitenin bağımsız belirleyicilerini saptamak için çok değişkenli lojistik regresyon kullanıldı. Bulgular: Her üç dönemde de pozitif sıvı dengesi, ayarlanmamış analizlerde anlamlı şekilde daha uzun mekanik ventilasyon süresi ile ilişkiliydi. Postoperatif ve toplam sıvı yüklenmesi, YBÜ kalış süresi ile anlamlı ilişkili bulundu (sırasıyla; β=0,23, p=0,021 ve β=0,11, p=0,014). İntraoperatif sıvı oranı, YBÜ mortalitesi ile ters yönlü anlamlı ilişki gösterdi (OR=0,71, p=0,039), ancak postoperatif ve toplam sıvı dengeleri ile anlamlı ilişki bulunmadı. Çok değişkenli analizde SOFA ve APACHE II skorları ile cerrahi süresi mortalite ile bağımsız ilişkiliydi. Ayrıca, toplam sıvı oranı da mortalite ile istatistiksel olarak anlamlı düzeyde ters yönlü bir ilişki gösterdi (OR=0,65, p=0,006). Sonuç: Pozitif postoperatif sıvı dengesi, özellikle uzamış YBÜ kalış süresi ile en güçlü ilişkili parametreydi. Pozitif intraoperatif sıvı dengesi ise beklenmedik şekilde düşük mortalite ile ilişkiliydi. Bu bulgular, hedefe yönelik perioperatif sıvı yönetiminin önemini vurgulamakta ve nedensel ilişkilerin açıklığa kavuşturulması için ileriye dönük çalışmalara ihtiyaç olduğunu göstermektedir.

Anahtar Kelimeler

• Sıvı tedavisi
• Postoperatif dönem
• Yoğun bakım üniteleri

Which Matters More: Intraoperative or Postoperative Fluid Balance? Insights From a Surgical ICU Cohort

Öz

Background: Perioperative fluid management is a key component of surgical care, yet the relative impact of intraoperative versus postoperative fluid balance on intensive care unit (ICU) outcomes remains unclear. This study aimed to evaluate the effect of intraoperative, postoperative, and total perioperative fluid balance on major ICU outcomes in patients undergoing elective surgery. Materials and Methods: This retrospective observational study included 570 adult patients who were admitted intubated to the ICU after elective surgery between January 1 and December 31, 2024. Fluid balance was calculated as a percentage of body weight and categorized into positive (≥5%) or negative-to-normal (<5%) for three time periods: intraoperative, postoperative, and cumulative perioperative. ICU outcomes included mechanical ventilation (MV) duration, ICU length of stay, and ICU mortality. Univariableregression analyses were performed, followed by multivariablelogistic regression to identify independent predictors of ICUmortality. Results: Positive fluid balance in all three timeframes wassignificantly associated with longer MV duration in unadjustedanalyses. Postoperative and cumulative fluid overload weresignificantly associated with prolonged ICU stay (β=0.23, p=0.021and β=0.11, p=0.014, respectively). Intraoperative fluid percentageshowed a significant inverse association with ICU mortality(OR=0.71, p=0.039), whereas postoperative and cumulativebalances were not. In multivariable analysis, SOFA and APACHEII scores and surgical duration were independently associated withICU mortality. Additionally, total fluid percentage demonstrated astatistically significant inverse association with mortality (OR=0.65,p=0.006). Conclusions: Postoperative positive fluid balance was the strongestpredictor of adverse ICU outcomes, particularly prolonged ICU stay.Intraoperative positive fluid balance demonstrated an unexpectedinverse relationship with mortality. These findings highlight theimportance of targeted perioperative fluid stewardship and supportthe need for prospective studies to clarify causal relationships.

Anahtar Kelimeler

• Fluid therapy
• Postoperative period
• Intensive careunits

Kaynakça

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