The Value Of Early Dynamic Weight Monitoring For Sever Trauma Patients In Intensive Care Unit

ObjectiveTo explore the relationship between weight change and clinic data as well as outcomes of severe trauma patients,so as to evaluate the value of daily weight monitoring in severe trauma patients.Methods:The severe trauma patients of this prospective study were collected in an Emergency Intensive Care Unit(EICU)department in a tertiary hospital from 1st June 2015 to 31st December 2015.The clinical data were collected,including demographic information(gender,age,etc.),Body Mass Index(BMI),Acute Physiology and Chronic Health Evaluation(APACHE ?),Injury Severity Score(ISS),shock,vasoactive agent,fever or diarrhea at admission or not,enternal nutrition within 48h or not,calorie,fluid indicators and outcomes.Weight,fluid balance,triceps skin fold thickness and biceps circumference were measured according to corresponding methods.Multivariate regression analysis and repeated measures analysis of variance were used.Results:1.65 patients were enrolled in the study.The age of these patients was 54± 17 and male accounted for 63.1%.BMI was 22.0±2.7 kilogram per square meter,ISS was 22±5 and APACHE ? was 15±6.2.The weight variation showed negative balance in the first week for the sever trauma patients.The variation of weight change decreased gradually with ICU stay and the standard deviation decreased from 1.37 to 0.34.3.There were nine patients died during hospitalization.The daily weight variation average 0.46±0.5 kilogram and weekly weight variation average 3.2±1.2 kilogram in the death-group patients.As for survival-group patients,the daily weight variation average-0.25±0.7 kilogram,and weekly weight variation average-1.8±1.5 kilogram.There was no significant difference between the two groups,for the difference between two day weight(F=0.918,P=0.482).However,there was significant difference between the two groups,for weight variation(F=90.94,P<0.001)or the cumulative weight variation within a week.4.The daily weight variation was moderate correlated with daily fluid balance(r=0.69,P<0.001).However,weak correlations were found between daily weight variation and triceps skin fold thickness and biceps circumference.5.According to linear regression analysis,only daily fluid variation was correlated with daily weight change(OR=0.54,P=0.01).However,risk factors of cumulative weight variation included female,higher ISS,higher BMI and daily positive weight balance.Enteral nutrition within 48h was associated with controlling weight increase(OR=-0.41).6.According to regression analysis,risk factors of mortality included aging,higher ISS,higher BMI,positive fluid balance and positive weight balance(OR were 1.05,1.39,1.03,2.01 and 3.05).Female and low ages were associated with reduced mechanical ventilation and reduced ICU stay(OR=-0.12/-0.04 and-0.46/-0.45).And the risk factors were shock,higher BMI,daily positive weight balance and higher ISS(2.6/3.09,0.48/0.49,0.48/0.43 and 0.14/0.07).Conclusions:1.The weight variation of severe trauma patients presented negative balance during the first week of ICU admission.However,Positive balance of weight variation was found in critically ill and death group patients.2.Correlation was found between cumulative weight variation and fluid balance,as well as sex,BMI and severity of disease.Early enteral nutrition was associated with controlling weight increase.3.Weight increase during the first week was associated with prolonged mechanical ventilation,ICU length of stay and mortality.