Trajectories of cumulative fluid balance and the association with pressure injuries in ICU patients.
Xiangping Chen, Peiqi Liu, Bingyan Zhu and 5 others
PMID 41367596WHAT IT FOUND
ICU patients whose cumulative fluid balance rose rapidly over the first 7 days had more pressure injuries, even after accounting for severity and ICU treatments.
Treat rapid accumulation as a skin-risk signal in nursing care, but this does not prove that changing fluids prevents injuries.
Key findings
01After adjustment, the rapid fluid accumulation trajectory was associated with all stages of pressure injuries (OR 1.63) and stage II or higher pressure injuries (OR 1.36).
02Pressure injuries occurred in 29.4% of the negative decrease group, 33.9% of the neutral balance group, 41.0% of the slow accumulation group, and 54.0% of the rapid accumulation group (P < 0.001).
03After full adjustment, the slow accumulation group (OR 1.16) and negative decrease group (OR 0.94) were not significantly associated with pressure injuries.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only patients with first ICU admissions and ICU stays longer than 7 days were analysed, so the findings may not apply to shorter ICU stays or repeat admissions. Patients with missing or outlier daily fluid-balance data were excluded, so the analysed group was not all ICU admissions. The study used records from one hospital, so the identified fluid-balance trajectories and pressure-injury records may differ in other settings. Baseline illness severity and ICU treatments differed across trajectory groups, and unmeasured factors could still explain part of the association. The follow-up was short, so the study cannot show that fluid accumulation caused pressure injuries.
Declared interests
The authors declared no conflict of interest. An author is credited with funding acquisition, but no funder or sponsor role is stated.
The easy way to misread this
Do not conclude that rapid fluid accumulation caused pressure injuries or that changing fluid balance will prevent them. This was a retrospective database cohort, and although the association persisted after adjustment, causation was not established.