SESSION TITLE: Miscellaneous
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: The aim of this project is to retrospectively assess the effects of a fluid goal tool utilized in a daily ICU checklist on positive fluid balance and fluid overload within the medical intensive care unit at a tertiary care center. The authors hypotesized that implementing a fluid balance rounding checklist in the intensive care unit environment that prompts providers to designate a fluid goal leads to less positive daily fluid balance and less fluid overload when compared to cases where the rounding tool was not used.
METHODS: A retrospective cohort database review study of patients that included fluid balance evaluation in an ICU rounding checklist. Consecutive hospitalized patients admitted to a medical ICU in which a sepsis response team activation occurred between July 2013, and June 2014, requiring admission for >48 hours compared to a historical control from the same ICU, composed of patients between July 2012 through June 2013.
RESULTS: Total 310 patients were observed retrospectively, 137 control and 173 from checklist groups. The median (IQR) age was 66.4 (56.5-78) years and 180 (58%) of were men. Median (IQR) BMI was 27.9 (23-35) in pre and 27.4 (23-35) post, p=0.4. Median APACHE IV at 24 hours was 86(73-105) and 81(70-102) respectively, p=0.14. Median (IQR) Fluid balance at 48 hours for the ICU stay was greater in pre; 6513 mL (3982-9720) vs. 5438 mL (2297-8550) in post, p=0.03. The median(IQR) intravenous fluids administered at 48 hours and during the ICU stay were both significantly decreased following implementatiuon of the checklist; 8490 mL (6176-11261) vs. 7465 mL (4849-9831) p=0.008 and 12664 mL (9240-19843) vs. 10807 mL (6924-15436) p=0.006 respectively. However, while the fluid balance for the whole ICU stay was greater in pre vs. post; 5483 mL (2854-9684) vs. 4557 mL (1243-8904), it did not reach statisticial siginificance, p=0.23. Median (IQR) days on mechanical ventilation were 2.9(1.7-5.8) compared to 2.4(1.4-5.0), p=0.07. Patients with fluid overload as defined as greater than 10% above admission weight were 38% (n=52) in pre vs 29%(N=50) in post; p=0.11.
CONCLUSIONS: Implementing a fluid balance item in an ICU rounding tool resulted in a modest improved fluid balance in first 48 hours, reduced IV fluid administration, and non-significant decreased fluid overload.
CLINICAL IMPLICATIONS: Simple paper or electronic based checklist use in ICU has potential to improve the prcoess of care, which in turn may decrease the mortality.