• Crit Care · Nov 2023

    Randomized Controlled Trial

    Fluid balance control in critically ill patients: results from as-treated analyses of POINCARE-2 randomized trial.

    • Adil Mansouri, Marie Buzzi, Sébastien Gibot, Claire Charpentier, Francis Schneider, Guillaume Louis, Hervé Outin, Alexandra Monnier, QuenotJean-PierreJPService de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, 21000, Dijon, France., Julio Badie, Laurent Argaud, Cédric Bruel, Marc Soudant, Nelly Agrinier, and the POINCARE-2 group.
    • CHRU Nancy Hôpitaux de Brabois, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, 9 Allée du Morvan, 54000, Vandœuvre-lès-Nancy, Nancy, France.
    • Crit Care. 2023 Nov 6; 27 (1): 426426.

    BackgroundIntention-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.MethodsPOINCARE‑2 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.ResultsA 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).ConclusionActual 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.© 2023. The Author(s).

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…