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Molin C, Wichmann S, Schønemann‐Lund M, Møller MH, Bestle MH. Fluid accumulation in adult ICU patients - A protocol for a scoping review. Acta Anaesthesiol Scand 2025; 69:e14584. [PMID: 39853691 PMCID: PMC11757096 DOI: 10.1111/aas.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 01/14/2025] [Indexed: 01/26/2025]
Abstract
INTRODUCTION Fluid accumulation in critically ill patients is associated with adverse outcomes. However, there is a substantial variability in the terminology and definitions used to describe fluid accumulation. We aim to provide an overview of evidence describing fluid accumulation in critically ill adult patients admitted to the intensive care unit (ICU), including how it is defined, patient characteristics associated with fluid accumulation, ICU population, and outcomes assessed. METHODS We will conduct a scoping review prepared according to the Preferred Reporting Items for Systematic and Meta-analysis extension for Scoping reviews (PRISMA-ScR). Pubmed, MEDLINE, EMBASE, and Cochrane Library will be searched systematically. All clinical studies reporting original data and investigating fluid accumulation, as defined by authors, in adult ICU patients will be included. We will assess the study design, the definition of fluid accumulation, ICU population, and the outcomes measured, categorised as patient-important or non-patient important, in the included studies. The results will be reported descriptively. The certainty of evidence will be assessed using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) on the research question level. DISCUSSION This scoping review will provide an overview of definitions used for fluid accumulation, and describe ICU patient populations, patient characteristics, and outcomes assessed in ICU research.
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Affiliation(s)
- Clara Molin
- Department of Anaesthesia and Intensive CareCopenhagen University Hospital – North ZealandHillerodDenmark
| | - Sine Wichmann
- Department of Anaesthesia and Intensive CareCopenhagen University Hospital – North ZealandHillerodDenmark
| | - Martin Schønemann‐Lund
- Department of Anaesthesia and Intensive CareCopenhagen University Hospital – North ZealandHillerodDenmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Morten Heiberg Bestle
- Department of Anaesthesia and Intensive CareCopenhagen University Hospital – North ZealandHillerodDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Bem RA, Lemson J. Evaluating fluid overload in critically ill children. Curr Opin Pediatr 2024; 36:266-273. [PMID: 38655808 DOI: 10.1097/mop.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW To review the evaluation and management of fluid overload in critically ill children. RECENT FINDINGS Emerging evidence associates fluid overload, i.e. having a positive cumulative fluid balance, with adverse outcome in critically ill children. This is most likely the result of impaired organ function due to increased extravascular water content. The combination of a number of parameters, including physical, laboratory and radiographic markers, may aid the clinician in monitoring and quantifying fluid status, but all have important limitations, in particular to discriminate between intra- and extravascular water volume. Current guidelines advocate a restrictive fluid management, initiated early during the disease course, but are hampered by the lack of high quality evidence. SUMMARY Recent advances in early evaluation of fluid status and (tailored) restrictive fluid management in critically ill children may decrease complications of fluid overload, potentially improving outcome. Further clinical trials are necessary to provide the clinician with solid recommendations.
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Affiliation(s)
- Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam Academic Medical Centers, location University of Amsterdam, Amsterdam
| | - Joris Lemson
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
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Wichmann S, Lange T, Perner A, Gluud C, Itenov TS, Berthelsen RE, Nebrich L, Wiis J, Brøchner AC, Nielsen LG, Behzadi MT, Damgaard K, Andreasen AS, Strand K, Järvisalo M, Strøm T, Eschen CT, Vang ML, Hildebrandt T, Andersen FH, Sigurdsson MI, Thomar KM, Thygesen SK, Troelsen TT, Uusalo P, Jalkanen V, Illum D, Sølling C, Keus F, Pfortmueller CA, Wahlin RR, Ostermann M, Aneman A, Bestle MH. Furosemide versus placebo for fluid overload in intensive care patients-The randomised GODIF trial second version: Statistical analysis plan. Acta Anaesthesiol Scand 2024; 68:130-136. [PMID: 37691474 DOI: 10.1111/aas.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Fluid overload is associated with increased mortality in intensive care unit (ICU) patients. The GODIF trial aims to assess the benefits and harms of fluid removal with furosemide versus placebo in stable adult patients with moderate to severe fluid overload in the ICU. This article describes the detailed statistical analysis plan for the primary results of the second version of the GODIF trial. METHODS The GODIF trial is an international, multi-centre, randomised, stratified, blinded, parallel-group, pragmatic clinical trial, allocating 1000 adult ICU patients with moderate to severe fluid overload 1:1 to furosemide versus placebo. The primary outcome is days alive and out of hospital within 90 days post-randomisation. With a power of 90% and an alpha level of 5%, we may reject or detect an improvement of 8%. The primary analyses of all outcomes will be performed in the intention-to-treat population. For the primary outcome, the Kryger Jensen and Lange method will be used to compare the two treatment groups adjusted for stratification variables supplemented with sensitivity analyses in the per-protocol population and with further adjustments for prognostic variables. Secondary outcomes will be analysed with multiple linear regressions, logistic regressions or the Kryger Jensen and Lange method as suitable with adjustment for stratification variables. CONCLUSION The GODIF trial data will increase the certainty about the effects of fluid removal using furosemide in adult ICU patients with fluid overload. TRIAL REGISTRATIONS EudraCT identifier: 2019-004292-40 and ClinicalTrials.org: NCT04180397.
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Affiliation(s)
- Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- The Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Theis S Itenov
- Department of Anaesthesia, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Rasmus E Berthelsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Koege, Denmark
| | - Jørgen Wiis
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne C Brøchner
- Department of Anaesthesia and Intensive Care, University Hospital of Southern Denmark, Kolding, Denmark
| | - Louise G Nielsen
- Department of Intensive Care, Odense University Hospital, Odense, Denmark
| | - Meike T Behzadi
- Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Kjeld Damgaard
- Department of Anaesthesia and Intensive Care, Regionshospital Nordjylland, Hjoerring, Denmark
| | - Anne S Andreasen
- Department of Intensive Care, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Kristian Strand
- Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Mikko Järvisalo
- Department of Internal Medicine, Kanta-Häme Central Hospital, Hameenlinna, Finland
| | - Thomas Strøm
- Department of Anaesthesia and Intensive Care, Sygehus Soenderjylland, Aabenraa, Denmark
| | - Camilla T Eschen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Gentofte Hospital, Gentofte, Denmark
| | - Marianne L Vang
- Department of Intensive Care, Regionshospitalet Randers, Randers, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Finn H Andersen
- Department of Intensive Care, Aalesund Hospital, Moere and Romsdal Health Trust, Aalesund, Norway
- Faculty of Medicine and Health Science, Department of Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Martin I Sigurdsson
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Katrin M Thomar
- Department of Anaesthesia and Intensive Care, Landspitali, Reykjavik, Iceland
| | - Sandra K Thygesen
- Department of Anaesthesia and Intensive Care, Regionshospitalet Goedstrup, Herning, Denmark
| | - Thomas T Troelsen
- Department of Anaesthesia and Intensive Care, Regionshospitalet Goedstrup, Herning, Denmark
| | - Panu Uusalo
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Dorte Illum
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Rebecka R Wahlin
- Department of Anaesthesia and Intensive Care, Sodersjukhuset AB, Stockholm, Sweden
| | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St. Thomas' Hospital, London, UK
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South Western Clinical School, University of New South Wales, Sydney, Australia
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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