Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data
Abstract Background Fluid balance gap (FBgap—prescribed vs. achieved) is associated with hospital mortality. Downtime is an important quality indicator for the delivery of continuous renal replacement therapy (CRRT). We examined the association of CRRT downtime with FBgap and clinical outcomes inclu...
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| Language: | English |
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BMC
2024-12-01
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| Series: | Journal of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s40560-024-00772-w |
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| author | Chloe Braun Tomonori Takeuchi Josh Lambert Lucas Liu Sarah Roberts Stuart Carter William Beaubien-Souligny Ashita Tolwani Javier A. Neyra |
| author_facet | Chloe Braun Tomonori Takeuchi Josh Lambert Lucas Liu Sarah Roberts Stuart Carter William Beaubien-Souligny Ashita Tolwani Javier A. Neyra |
| author_sort | Chloe Braun |
| collection | DOAJ |
| description | Abstract Background Fluid balance gap (FBgap—prescribed vs. achieved) is associated with hospital mortality. Downtime is an important quality indicator for the delivery of continuous renal replacement therapy (CRRT). We examined the association of CRRT downtime with FBgap and clinical outcomes including mortality. Methods This is a retrospective cohort study of critically ill adults receiving CRRT utilizing both electronic health records (EHR) and CRRT machine data. FBgap was calculated as achieved minus prescribed fluid balance. Downtime, or percent treatment time loss (%TTL), was defined as CRRT downtime in relation to the total CRRT time. Data collection stopped upon transition to intermittent hemodialysis when applicable. Linear and logistic regression models were used to analyze the association of %TTL with FBgap and hospital mortality, respectively. Covariates included demographics, Sequential Organ Failure Assessment (SOFA) score at CRRT initiation, use of organ support devices, and the interaction between %TTL and machine alarms. Results We included 3630 CRRT patient-days from 500 patients with a median age of 59.5 years (IQR 50–67). Patients had a median SOFA score at CRRT initiation of 13 (IQR 10–16). Median %TTL was 8.1% (IQR 4.3–12.5) and median FBgap was 17.4 mL/kg/day (IQR 8.2–30.4). In adjusted models, there was a significant positive relationship between FBgap and %TTL only in the subgroup with higher alarm frequency (6 + alarms per CRRT-day) (β = 0.87 per 1% increase, 95%CI 0.48–1.26). No association was found in the subgroups with lower alarm frequency (0–2 and 3–5 alarms). There was no statistical evidence for an association between %TTL and hospital mortality in the adjusted model with the interaction term of alarm frequency. Conclusions In critically ill adult patients undergoing CRRT, %TTL was associated with FBgap only in the subgroup with higher alarm frequency, but not in the other subgroups with lower alarms. No association between %TTL and mortality was observed. More frequent alarms, possibly indicating unexpected downtime, may suggest compromised CRRT delivery and could negatively impact FBgap. |
| format | Article |
| id | doaj-art-fb383329a95742e185274759db5ebd8a |
| institution | Kabale University |
| issn | 2052-0492 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj-art-fb383329a95742e185274759db5ebd8a2025-01-05T12:09:57ZengBMCJournal of Intensive Care2052-04922024-12-011211910.1186/s40560-024-00772-wAssociation of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine dataChloe Braun0Tomonori Takeuchi1Josh Lambert2Lucas Liu3Sarah Roberts4Stuart Carter5William Beaubien-Souligny6Ashita Tolwani7Javier A. Neyra8The University of Alabama at BirminghamThe University of Alabama at BirminghamUniversity of CincinnatiPublic Health Sciences DivisionThe University of Alabama at BirminghamThe University of Alabama at BirminghamCentre Hospitalier de L’Universite de MontrealThe University of Alabama at BirminghamThe University of Alabama at BirminghamAbstract Background Fluid balance gap (FBgap—prescribed vs. achieved) is associated with hospital mortality. Downtime is an important quality indicator for the delivery of continuous renal replacement therapy (CRRT). We examined the association of CRRT downtime with FBgap and clinical outcomes including mortality. Methods This is a retrospective cohort study of critically ill adults receiving CRRT utilizing both electronic health records (EHR) and CRRT machine data. FBgap was calculated as achieved minus prescribed fluid balance. Downtime, or percent treatment time loss (%TTL), was defined as CRRT downtime in relation to the total CRRT time. Data collection stopped upon transition to intermittent hemodialysis when applicable. Linear and logistic regression models were used to analyze the association of %TTL with FBgap and hospital mortality, respectively. Covariates included demographics, Sequential Organ Failure Assessment (SOFA) score at CRRT initiation, use of organ support devices, and the interaction between %TTL and machine alarms. Results We included 3630 CRRT patient-days from 500 patients with a median age of 59.5 years (IQR 50–67). Patients had a median SOFA score at CRRT initiation of 13 (IQR 10–16). Median %TTL was 8.1% (IQR 4.3–12.5) and median FBgap was 17.4 mL/kg/day (IQR 8.2–30.4). In adjusted models, there was a significant positive relationship between FBgap and %TTL only in the subgroup with higher alarm frequency (6 + alarms per CRRT-day) (β = 0.87 per 1% increase, 95%CI 0.48–1.26). No association was found in the subgroups with lower alarm frequency (0–2 and 3–5 alarms). There was no statistical evidence for an association between %TTL and hospital mortality in the adjusted model with the interaction term of alarm frequency. Conclusions In critically ill adult patients undergoing CRRT, %TTL was associated with FBgap only in the subgroup with higher alarm frequency, but not in the other subgroups with lower alarms. No association between %TTL and mortality was observed. More frequent alarms, possibly indicating unexpected downtime, may suggest compromised CRRT delivery and could negatively impact FBgap.https://doi.org/10.1186/s40560-024-00772-wFluid managementCRRTMortalityAKIDowntime |
| spellingShingle | Chloe Braun Tomonori Takeuchi Josh Lambert Lucas Liu Sarah Roberts Stuart Carter William Beaubien-Souligny Ashita Tolwani Javier A. Neyra Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data Journal of Intensive Care Fluid management CRRT Mortality AKI Downtime |
| title | Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data |
| title_full | Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data |
| title_fullStr | Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data |
| title_full_unstemmed | Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data |
| title_short | Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data |
| title_sort | association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes a retrospective cohort analysis utilizing ehr and machine data |
| topic | Fluid management CRRT Mortality AKI Downtime |
| url | https://doi.org/10.1186/s40560-024-00772-w |
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