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

Yıl 2026, Sayı: Advanced Online Publication, 17.03.2026

Furkan Tontu , Payam Rahimi

https://izlik.org/JA83EB49UE

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

Etik Beyan

Ethical approval was obtained from the Gaziantep University Non-Interventional Clinical Research Ethics Committee prior to the study (approval no: 2026/78, date: January 21, 2026).

Destekleyen Kurum

Bu çalışma için herhangi bir dış finansal destek alınmamıştır.

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

https://izlik.org/JA83EB49UE

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

Etik Beyan

Ethical approval was obtained from the Gaziantep University Non-Interventional Clinical Research Ethics Committee prior to the study (approval no: 2026/78, date: January 21, 2026).

Destekleyen Kurum

No external funding or financial support was received for this study.

Kaynakça

• 1. Bayirli H, Tekerek NU, Koker A, Dursun O. Relationship between fluid overload and mortality and morbidity in pediatric intensive care unit. Med Intensiva. 2025;49(3):125-34.
• 2. Messmer AS, Zingg C, Müller M, Gerber JL, Schefold JC, Pfortmueller CA. Fluid overload and mortality in adult critical care patients—a systematic review and meta-analysis of observational studies. Crit Care Med. 2020;48(12):1862-70.
• 3. Lee J, de Louw E, Niemi M, Nelson R, Mark RG, Celi LA, et al. Association between fluid balance and survival in critically ill patients. J Intern Med. 2015;277(4):468-77.
• 4. Barmparas G, Liou D, Lee D, Fierro N, Bloom M, Ley E, et al. Impact of positive fluid balance on critically ill surgical patients: a prospective observational study. J Crit Care. 2014;29(6):936-41.
• 5. Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol. 2016;17(1):109.
• 6. Frazee E, Kashani K. Fluid management for critically ill patients: a review of the current state of fluid therapy in the intensive care unit. Kidney Dis. 2016;2(2):64-71.
• 7. Neyra JA, Li X, Canepa-Escaro F, Adams-Huet B, Toto RD, Yee J, et al. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease. Crit Care Med. 2016;44(10):1891-900.
• 8. Balakumar V, Murugan R, Sileanu FE, Palevsky P, Clermont G, Kellum JA. Both positive and negative fluid balance may be associated with reduced long-term survival in the critically ill. Crit Care Med. 2017;45(8):e749-57.
• 9. Patil VP, Salunke BG. Fluid overload and acute kidney injury. Indian J Crit Care Med. 2020;24(Suppl 3):S94.
• 10. Kellum JA, Elbers PWG, eds. Stewart’s Textbook of Acid-Base. 2nd ed. UK: Lulu Enterprises; 2009. 504 p.
• 11. Tontu F, Aşar S, Bilgin BÖ, Yıldız GÖ, Tontu KA, Çukurova Z. Stewart’s approach for acid-base disorders: does the strong ion difference and effects have an impact on intensive care unit mortality? Turk J Intensive Care. 2023;21(1):25-32.
• 12. Gucyetmez B, Atalan HK. Non-lactate strong ion difference: a clearer picture. J Anesth. 2016;30(3):391-6.
• 13. Tontu F. Fluid selection in renal transplant patients: considerations for hyperkalemia management. Turk J Anaesthesiol Reanim. 2025;53(3):138-40.
• 14. Zhao CC, Ye Y, Li ZQ, Wu XH, Zhao C, Hu ZJ. Effect of goal-directed fluid therapy on renal function in critically ill patients: a systematic review and meta-analysis. Ren Fail. 2022;44(1):777-89.
• 15. Perner A, Prowle J, Joannidis M, Young P, Hjortrup PB, Pettilä V. Fluid management in acute kidney injury. Intensive Care Med. 2017;43(6):807-15.
• 16. Ostermann M, Liu K, Kashani K. Fluid management in acute kidney injury. Chest. 2019;156(3):594-603.
• 17. Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4 Suppl):S117-S314.
• 18. Besen BAMP, Gobatto ALN, Melro LMG, Maciel AT, Park M. Fluid and electrolyte overload in critically ill patients: an overview. World J Crit Care Med. 2015;4(2):116.
• 19. Finfer S, Myburgh J, Bellomo R. Intravenous fluid therapy in critically ill adults. Nat Rev Nephrol. 2018;14(9):541-57.
• 20. Van Regenmortel N, Verbrugghe W, Roelant E, Van den Wyngaert T, Jorens PG. Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population. Intensive Care Med. 2018;44(4):409-17.
• 21. Malbrain M, Marik P, Witters I, Cordemans C, Kirkpatrick A, Roberts D, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anestezjol Intens Ter. 2014;46(5):377-96.
• 22. Silversides JA, Fitzgerald E, Manickavasagam US, Lapinsky SE, Nisenbaum R, Hemmings N, et al. Deresuscitation of patients with iatrogenic fluid overload is associated with reduced mortality in critical illness. Crit Care Med. 2018;46(10):1600-7.
• 23. Briassoulis G, Antonopoulou T, Velegraki J, Ilia S, Kondili E. Fluid creep as an independent predictor of fluid overload and mortality in critically ill patients: a cohort study. Life. 2025;15(12):1900.
• 24. Waskowski J, Salvato SM, Müller M, Hofer D, Van Regenmortel N, Pfortmueller CA. Choice of creep or maintenance fluid type and their impact on total daily ICU sodium burden in critically ill patients: a systematic review and meta-analysis. J Crit Care. 2023;78:154403.
• 25. Rahimi P, Tontu F, Khoundabi B, Aşar S, Nuhoğlu Ç, Yücel Yenice T, et al. Balancing chloride and glucose in critical illness: a 10-year study on diluent strategies and ICU outcomes. J Clin Med. 2025;14(23):8573.