High positive fluid balance could be harmful for the brain in shock patients

High positive fluid balance could be harmful for the brain in shock patients Duc Nam Nguyen, Luc Huyghens, Johan Schiettecatte, Johan Smitz, Jean-Louis Vincent Universitair Ziekenhuis Brussels, Belgium Erasme University Hospital Brussels, Belgium Background/Purpose: High positive fluid balance aggravates kidney and lung injury in critically ill patients, but it is not known if this could be harmful to the brain. We investigated whether high positive fluid balance was associated with brain dysfunction and delirium in shock patients including septic and cardiogenic shock. Methods: Cumulative fluid balance during the first 5 days after ICU admission was evaluated in 100 shock patients. Delirium and coma were assessed using the Richmond Agitation Sedation Scale (RASS) and the Confusion Assessment Method (CAM-ICU). Stroke and hemorrhage were confirmed by computed brain tomography. Serum biomarker of brain injury S100B protein was measured during the first 3 days after ICU admission. Results: Delirium developed in 65 patients (65%). Coma, stroke, and hemorrhage developed in 9 patients (9%). Patients who developed brain dysfunction experienced higher S100B levels (P = .02), higher cumulative fluid balance (P = .01), and higher ICU mortality (P = .01) than the patients who did not. Multivariate logistic regression showed that the SOFA score at ICU admission (odds ratio [OR], 1.15; 95% CI 1.05-1.28; P = .004) and the positive cumulative fluid balance during the first 5 days (OR, 1.09; 95% CI, 1.05-1.021; P = .01) were associated with the development of brain dysfunction and delirium. Conclusions: High positive fluid balance is associated with the development of brain dysfunction in shock patients.