The impact of negative fluid balance on weaning from mechanical ventilation on more than 60 years old critical patients

doi:10.3969/j.issn.1002-1949.2015.08.005

Abstract：Obj ective To investigate whether limited fluid management improves weaning outcomes compared with different fluid management on ICU elderly patients.Methods The design was a prospective, randomized, parallel group study in our Emergency Intensive Medicine Department. Forty-two patients who were up to weaning conditions were included from Feb 2013 to Feb 2015.The patients were divided into treatment group negative fluid balance( A group) and control group ( B group) according to random number table, with 21 cases in each group.A group received negative liquid balance 2 days before weaning and B group received positive fluid balance.Baseline indexes of two groups were compared, including respiration rate ( RR), heart rate, mean arterial pressure ( MAP), central venous pressure ( CVP) , blood gas, APACHEⅡ score, N-terminal -pro-brain natriuretic peptide (NT -pro -BNP).After ventilator weaning, liquid balance during weaning, failures of weaning, total length of mechanical ventilation were compared .Rseu lts Patients who received negative fluid balance had shorter mechanical ventilation time, lower NT -pro -BNP level. There were significant differences in total length of mechanical ventilation [(5.99 ±1.83)d vs (8.04 ±3.99) d], NT-pro-BNP [(424.71 ±302.67)pg/mL vs (653.19 ±483.39) pg/mL] between two groups (P<0.05).The success of weaning in A group was lower, but there was no statistically significant difference between the tow groups (85.7% vs 66.7%).There was no statistically significant difference in the heart rate, RR, MAP, CVP at the end of the investigation between the two groups ( P >0.05 ) . Conclusion Our results suggest that negative fluid balance strategies may be helpful in patients weaning from the mechanical ventilation.Its mechanism may be related to improvement of cardiac function in these elderly patients.