Fluid balance in critically ill patients. Should we really rely on it

摘要: Background The computation of fluid balances (FBs) by subtracting outputs from inputs is a common critical care practice. Limited information exists about the accuracy and consistency nurse-registered cumulative FBs regarding value suggested corrections for non-measurable losses. Methods From 147 ICU patients, we prospectively evaluated their relationship to changes in body weight (BW). Standardised measurements BW were performed on admission discharge. FB charts accurately reviewed arithmetic errors corrected. Net adjusted (considering sensible or insensible losses/fever/liquid faeces) analysed all patients 3 subgroups (cardiac-cerebral, septic, others). Agreement between was calculated according defined confounding variables. Results Cumulative inaccurate 49 cases (33%) with ranging -3606 mL +2020 mL. total (average daily) difference measured (mean ± SD) 0.185±1.874 kg (0.101±1.020 kg). Correlation (r(2)) Bland-Altman agreement poor net (0.552 -1.26±5.41 kg) slightly better (0.714 +0.18±3.68 Standard deviations average daily differences always >1 L. Correction as literature not useful. New multiple regression models only modestly improved correlation. Conclusion For large portion are neither accurate nor do they agree standardised measurements. Patient clinical decision-making should be based more objective techniques.