Fluid balance control in critically ill patients: results from as-treated analyses of POINCARE-2 randomized trial.
Crit Care
; 27(1): 426, 2023 11 06.
Article
in En
| MEDLINE
| ID: mdl-37932787
ABSTRACT
BACKGROUND:
Intention-to-treat analyses of POINCARE-2 trial led to inconclusive results regarding the effect of a conservative fluid balance strategy on mortality in critically ill patients. The present as-treated analysis aimed to assess the effectiveness of actual exposure to POINCARE-2 strategy on 60-day mortality in critically ill patients.METHODS:
POINCARE2 was a stepped wedge randomized controlled trial. Eligible patients were ≥ 18 years old, under mechanical ventilation and had an expected length of stay in ICU > 24 h. POINCARE-2 strategy consisted of daily weighing over 14 days, and subsequent restriction of fluid intake, administration of diuretics, and/or ultrafiltration. We computed a score of exposure to the strategy based on deviations from the strategy algorithm. We considered patients with a score ≥ 75 as exposed to the strategy. We used logistic regression adjusted for confounders (ALR) or for an instrumental variable (IVLR). We handled missing data using multiple imputations.RESULTS:
A total of 1361 patients were included. Overall, 24.8% of patients in the control group and 69.4% of patients in the strategy group had a score of exposure ≥ 75. Exposure to the POINCARE-2 strategy was not associated with 60-day all-cause mortality (ALR OR 1.2, 95% CI 0.85-1.55; IVLR OR 1.0, 95% CI 0.76-1.33).CONCLUSION:
Actual exposure to POINCARE-2 conservative strategy was not associated with reduced mortality in critically ill patients. Trial registration POINCARE-2 trial is registered at ClinicalTrials.gov (NCT02765009). Registered 29 April 2016.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Water-Electrolyte Balance
/
Critical Illness
Limits:
Adolescent
/
Adult
/
Humans
Language:
En
Journal:
Crit Care
Year:
2023
Document type:
Article
Affiliation country: