Yoğun Bakım Hastalarında Rutin İdame Sıvısı Uygulanmayan Restriktif Sıvı Tedavisi Yaklaşımının Asit-Baz Dengesi ve Böbrek Fonksiyonları Üzerine Etkisi

Öz

Amaç: Bu çalışma, yoğun bakım ünitesinde rutin idame solüsyonu uygulanan dönem ile idame solüsyonu verilmeden, hastanın günlük sıvı gereksiniminin klinik ve laboratuvar parametreler doğrultusunda değerlendirildiği restriktif sıvı yönetimi yaklaşımının asit-baz dengesi ve böbrek fonksiyonları üzerine etkilerini karşılaştırmayı amaçlamıştır.

Materyal ve metod: Bu tek merkezli, retrospektif, gözlemsel çalışmada, ardışık iki klinik dönemde yoğun bakımda yatan erişkin hastaların verileri incelendi. Birinci dönemde rutin idame sıvısı uygulanırken, ikinci dönemde idame sıvısı verilmeden hastaların sıvı gereksinimi günlük klinik değerlendirme ile karşılandı. Demografik veriler, verilen intravenöz sıvı miktarı, elektrolitler, kan gazı parametreleri, serum üre ve kreatinin değerleri ile non-laktat güçlü iyon farkı (strong ion difference, SIDnl) değerleri yatış günü (0. gün) ve 5. gün için kaydedildi. Akut böbrek hasarı (ABH), KDIGO kriterlerine göre değerlendirildi.

Bulgular: Restriktif sıvı yönetimi uygulanan dönemde toplam verilen intravenöz sıvı miktarı, ABH insidansı ve maksimum ABH evresi anlamlı olarak daha düşük bulundu. Buna karşın serum üre ve kreatinin düzeyleri girişte ve 5. günde iki grup arasında benzerdi. Restriktif grupta başlangıç SIDnl değerleri daha düşük olmasına rağmen, izlem sürecinde normal aralığa yaklaşmış ve 5.gün SIDnl değerleri gruplar arasında benzer bulunmuştur.Mortalite restriktif grupta daha düşük saptanmış ancak istatistikselanlamlılığa ulaşmamıştır.

Sonuç: Rutin idame sıvılarının uygulanmaması vebireyselleştirilmiş restriktif sıvı yönetimi yaklaşımı, yoğun bakımhastalarında daha düşük sıvı maruziyeti ile birlikte daha düşükABH insidansı ve ABH şiddeti ile ilişkili bulunmuştur. Bu bulgular,gereksiz sıvı yüklenmesinin azaltılmasının böbrek fonksiyonlarınınkorunmasına katkı sağlayabileceğini düşündürmektedir.

Anahtar Kelimeler

• Restriktif sıvı tedavisi
• İdame sıvısı
• Akutböbrek hasarı
• Sıvı yüklenmesi
• Asit-baz dengesi

Effect of a Restrictive Fluid Therapy Strategy Without Routine Maintenance Fluids on Acid-Base Balance and Renal Function in Critically Ill Patients

Öz

Background: This study aimed to compare the effects of conventional maintenance fluid administration and a restrictive fluid management strategy without routine maintenance fluids on acid–base balance and renal function in critically ill patients.

Materials and Methods: In this single-center, retrospective observational study, adult ICU patients hospitalized during two consecutive clinical periods were analyzed. During the first period, routine maintenance fluids were administered, whereas during the second period, fluid therapy was individualized without routine maintenance fluids based on daily clinical and laboratory assessment. Demographic data, administered intravenous fluid volume, electrolytes, blood gas parameters, serum urea and creatinine levels, and non-lactate strong ion difference (SIDnl) were recorded at ICU admission (day 0) and day 5. Acute kidney injury (AKI) was assessed according to KDIGO criteria.

Results: The restrictive fluid period was associated with significantly lower total intravenous fluid administration, lower AKI incidence, and lower maximum AKI stage. Serum urea and creatinine levels were similar between groups at baseline and day 5.Although baseline SIDnl values were lower in the restrictivegroup, they normalized during follow-up, and day 5 SIDnl valueswere comparable between groups. Mortality was numerically lowerin the restrictive group but did not reach statistical significance.

Conclusions: Omission of routine maintenance fluids andimplementation of an individualized restrictive fluid strategy wereassociated with reduced fluid exposure, lower AKI incidence, andlower AKI severity in critically ill patients. These findings suggestthat minimizing unnecessary fluid administration may contributeto renal protection in the ICU.

Anahtar Kelimeler

• Restrictive fluid therapy
• Maintenance fluids
• Acutekidney injury
• Fluid overload
• Acid-base balance

Kaynakça

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