Intake and output evaluation in post-surgical patients during ICU stay

Document Type : Original Article

Authors

College of Nursing, University of Mosul, Mosul, Iraq

10.22034/ncm.2023.409911.1108

Abstract

Background: Disturbances in fluid and electrolyte balance are common clinical issues encountered in the intensive care unit (ICU), and recent studies have shown that they can lead to increased morbidity and mortality rates among critically ill patients.
Objectives: This study aims to monitor patients' fluid and electrolyte imbalances post-operatively throughout their ICU stay.
Methods: The study design involved monitoring the patients' intake and output of fluids and electrolytes during their ICU stay from November 1st, 2022, until July 13th, 2023. This was carried out using a systematic approach that accounted for the patients' general health characteristics and included relevant information related to the patients' surgical history, duration of surgery, complications post-anesthesia, and the type of surgical intervention.
Results: The study revealed that 55.6% of the patient sample had surgery that lasted 1-3 hours. The majority of patients complained of apnea post-anesthesia, and laparotomy intervention was the most common surgical operation (37.7%). Major surgeries accounted for 95.6% of the interventions, while minor surgeries only accounted for 4.4%.
Conclusion: The study highlights that fluid and electrolyte imbalances are major problems in post-operative patients, particularly those admitted to the ICU. The most common complications related to fluid and electrolyte imbalance in ICU patients were either hypertension or hypotension, with a consequent deterioration of the patients' overall health status.

Keywords

Main Subjects


  1. Larivée NL, Michaud JB, More KM, Wilson JA, Tennankore KK. Hyperkalemia: Prevalence, Predictors and Emerging Treatments. Cardiol Ther. 2023;12(1):35-63. doi:10.1007/s40119-022-00289-z PMid:36503972 PMCid:PMC9742042
  2. Kleindienst A, Georgiev S, Schlaffer SM, Buchfelder M. Tolvaptan versus fluid restriction in the treatment of hyponatremia resulting from SIADH following pituitary surgery. J Endocr  Soc. 2020;4(7): bvaa068. doi:10.1210/jendso/bvaa068 PMid:32666012 PMCid:PMC7326480
  3. Hazzard E, Gulliver S, Walton K, McMahon AT, Milosavljevic M, Tapsell L. The patient experience of having a feeding tube during treatment for head and neck cancer: a systematic literature review. Clin Nutr ESPEN. 2019;33:66-85.doi:10.1016/j.clnesp.2019.07.005 PMid:31451279
  4. Indrebø M, Berg A, Holmstrøm H, Seem E, Guthe HJ, Wiig H, et al. Fluid accumulation in the staged Fontan procedure: the impact of colloid osmotic pressures. Interact Cardiovasc Thorac Surg. 2019;28(4):510-7. doi:10.1093/icvts/ivy298 PMid:30371784
  5. Boldt J, Priebe HJ. Intravascular volume replacement therapy with synthetic colloids: is there an influence on renal function?. Anesth Analg. 2003;96(2):376-82. doi: 1097/00000539-200302000-00014 PMid:12538180
  6. Fatima SP, Prashanthi DP. Serum electrolytes as mortality indicators in hypertension cases. Eur J Mol Clin Med. 2022;9(7): 3721-8.
  7. Decaux G, Gankam Kengne F. Hypertonic saline, isotonic saline, water restriction, long loops diuretics, urea or vaptans to treat hyponatremia. Expert Rev Endocr Metabol. 2020;15(3):195-214. doi:10.1080/17446651.2020.1755259 PMid:32401559
  8. Pearce D, Manis AD, Nesterov V, Korbmacher C. Regulation of distal tubule sodium transport: mechanisms and roles in homeostasis and pathophysiology. Pflügers Arch Eur J Physiol. 2022;474(8):869-84. doi:10.1007/s00424-022-02732-5 PMid:35895103 PMCid:PMC9338908
  9. Argaiz ER, Koratala A, Reisinger N. Comprehensive assessment of fluid status by point-of-care ultrasonography. Kidney 360. 2021; 2(8):1326. doi:10.34067/KID.0006482020 PMid:35369665 PMCid:PMC8676400
  10. Ibrahim SL, Alzubaidi ZF, Al-Maamory FA. Electrolyte disturbances in a sample of hospitalized patients from Iraq. J Med Life. 2022;15(9):1129. doi:10.25122/jml-2022-0039 PMid:36415511 PMCid:PMC9635247
  11. Tewelde SZ, Mattu A. Electrocardiography in the Emergency Department. Textbook of Emergency Cardiology. 2021:30.
  12. Friars D, Walsh O, McNicholas F. Assessment and management of cardiovascular complications in eating disorders. J Eat Disord. 2023;11(1):1-2. doi:10.1186/s40337-022-00724-5 PMid:36717950 PMCid:PMC9886215
  13. Pearce D, Manis AD, Nesterov V, Korbmacher C. Regulation of distal tubule sodium transport: mechanisms and roles in homeostasis and pathophysiology. Pflügers Arch Eur J Physiol. 2022;474(8):869-84. doi:10.1007/s00424-022-02732-5 PMid:35895103 PMCid:PMC9338908
  14. Das J, Das D, Mandal S, Maitra BC, Acharjee A, Mandal M. Serum sodium and water imbalance after sellar, suprasellar, and parasellar surgeries: A prospective and observational study. Asian J Med Sci. 2023;14(4). doi:10.3126/ajms.v14i4.51410
  15. Upadhyay S, Bhalerao N, Pratinidhi SA. Study of level of consciousness and electrolyte abnormalities in patient admitted to intensive care unit (ICU). Int J Contemp Med Res. 2017;4(8):1739-42.
  16. Van Regenmortel N, Verbrugghe W, Roelant E, Van den Wyngaert T, Jorens PG. Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population. Intensive Care Med. 2018; 44: 409-17. doi:10.1007/s00134-018-5147-3 PMid:29589054 PMCid:PMC5924672
  17. Siddika N, Anowar MN, Islam MS, Mallick DR. Characteristics of Adult Intensive Care Unit Patients at a University Hospital. Open Access Libr J. 2023 ;10(3):1-5. doi:10.4236/oalib.1109891
  18. Arena G, Cumming C, Lizama N, Mace H, Preen D. Hospital length of stay and readmission after elective surgery: a comparison of current and former smokers with non-smokers. 2023. doi:10.21203/rs.3.rs-2910058/v1
  19. Azarasa M, Azarfarin R, Changizi A, Alizadehasl A. Substance use among Iranian cardiac surgery patients and its effects on short-term outcome. Anesth Analg. 2009;109(5):1553-9. doi:10.1213/ANE.0b013e3181b76371 PMid:19843794
  20. Rubinsky AD, Sun H, Blough DK, Maynard C, Bryson CL, Harris AH, et al. AUDIT-C alcohol screening results and postoperative inpatient health care use. J Am Coll Surg. 2012; 214(3):296-305. doi:10.1016/j.jamcollsurg.2011.11.007 PMid:22244208
  21. Wang AS, Dhillon NK, Linaval NT, Rottler N, Yang AR, Margulies DR, et al. The impact of iv electrolyte replacement on the fluid balance of critically ill surgical patients. Am Surg. 2019;85 (10): 1171-4. doi:10.1177/000313481908501021 PMid:31657318
  22. Asehnoune K, Le Moal C, Lebuffe G, Le Penndu M, Josse NC, Boisson M, et al. Effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery: multicentre, double blind, randomised controlled trial. BMJ. 2021;373. doi:10.1136/bmj.n1162 PMid:34078591 PMCid:PMC8171383
  23. Martini V, Lederer AK, Laessle C, Makowiec F, Utzolino S, Fichtner-Feigl S, et al. Clinical characteristics and outcomes of surgical patients with intensive care unit lengths of stay of 90 days and greater. Crit Care Res Pract. 2017;2017. doi:10.1155/2017/9852017 PMid:28828185 PMCid:PMC5554573
  24. Mun E, Ceria-Ulep C, Umbarger L, Nakatsuka C. Trend of decreased length of stay in the intensive care unit (ICU) and in the hospital with palliative care integration into the ICU. Perm J. 2016; 20(4). doi:10.7812/TPP/16-036 PMid:27644048 PMCid:PMC5101091
  25. Moore D, Durie ML, Bampoe S, Buizen L, Darvall JN. The risk of postoperative deterioration of non-cardiac surgery patients with ICU referral status who are admitted to the regular ward: a retrospective observational cohort study. Patient Saf Surg. 2021; 15:1-6. doi:10.1186/s13037-021-00283-9 PMid:33612120 PMCid:PMC7897383
  26. Malbrain ML, Langer T, Annane D, Gattinoni L, Elbers P, Hahn RG, et al. Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Ann Intensive Care. 2020;10:1-9. doi:10.1186/s13613-020-00679-3 PMid:32449147 PMCid:PMC7245999
  27. Chittawatanarat K, Chuntrasakul C. Enteral feeding in surgical critically ill patients. Thai J Surg. 2006;27(1):5-10.
  28. EuroSurg Collaborative, Glasbey JC, Bibi S, Pata F, Ozkan BB, Van Straten S, Hodson J, et al. Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study. Colorectal Dis. 2020;22(12):2288-97. doi:10.1111/codi.15311 PMid:34092023
  29. Rajebhosale R, Miah M, Centea D, Cleto C, Yusuf R, Ravi P, et al. Are we monitoring urine output for the surgical patients in ward settings while indicated or planned?. Open Access Libr J. 2020; 7 (7):1-4. doi:10.4236/oalib.1106498
Volume 2, Issue 4
September 2023
Pages 170-179
  • Receive Date: 03 July 2023
  • Revise Date: 18 August 2023
  • Accept Date: 28 August 2023