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首页> 外文期刊>Prehospital emergency care >Association Between Intravenous Fluid Bolus and Biomarker Trajectory During Prehospital Care
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Association Between Intravenous Fluid Bolus and Biomarker Trajectory During Prehospital Care

机译：静脉内液体推注和生物标志物轨迹之间的关联在前护理期间

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Background: Patients with acute illness who receive intravenous (IV) fluids prior to hospital arrival may have a lower in-hospital mortality. To better understand whether this is a direct treatment effect or epiphenomenon of downstream care, we tested the association between a prehospital fluid bolus and the change in inflammatory cytokines measured at prehospital and emergency department timepoints in a sample of non-trauma, non-cardiac arrest patients at risk for critical illness. Methods: In a prospective cohort study, we screened 4,013 non-trauma, non-cardiac arrest encounters transported by City of Pittsburgh Emergency Medical Services (EMS) to 2 hospitals from August 2013 to February 2014. In 345 patients, we measured prehospital biomarkers (IL-6, IL-10, and TNF) at 2 time points: the time of prehospital IV access placement by EMS and at ED arrival. We determined the relative change for marker X as: ([X-ED - X-EMS]/X-EMS). We determined the risk-adjusted association between prehospital IV fluid bolus and relative change for each marker using multivariable linear regression. Results: Among 345 patients, 88 (26%) received a prehospital IV fluid bolus and 257 (74%) did not. Compared to patients who did not receive prehospital fluids, median prehospital IL-6 was greater initially in subjects receiving a prehospital IV fluid bolus (22.3 [IQR 6.4-113] vs. 11.5 [IQR 5.5-47.6]). Prehospital IL-10 and TNF were similar in both groups (IL-10: 3.5 [IQR 2.2-25.6] vs. 3.0 [IQR 1.9-9.0]; TNF: 7.5 [IQR 6.4-10.4] vs. 6.9 [IQR 6.0-8.3]). After adjustment for demographics, illness severity, and prehospital transport time, we observed a relative decrease in IL-6 at hospital arrival in those receiving a prehospital fluid bolus (adjusted beta = -10.0, 95% CI: -19.4, -0.6, p = 0.04), but we did not detect a significant change in IL-10 (p = 0.34) or TNF (p = 0.53). Conclusions: Among non-trauma, non-cardiac arrest patients at risk for critical illness, a prehospital IV fluid bolus was associated with a relative decrease in IL-6, but not IL-10 or TNF.
机译：背景：患有急性疾病的患者在医院到达之前接受静脉内（IV）液体可能具有较低的住院医生死亡率。为了更好地了解这是否是下游护理的直接治疗效果或Epiphenomenon，我们测试了在非创伤，非心动骤停的样本中在预孢子和急诊株时测量的炎症流体推注与炎症细胞因子之间的关系。患者有危险的疾病。方法：在一项潜在的队列研究中，我们从2013年8月到2014年8月，匹兹堡紧急医疗服务（EMS）到2家医院运输的4,013名非创伤，非心脏骤停遭遇。在345名患者中，我们测量了预孢子生物标志物（ IL-6，IL-10和TNF）在2个时间点：EMS和ED到达的预休霍斯IV访问安置的时间。我们确定了标记x的相对变化为：（[X-ED-X-EMS] / X-EMS）。我们确定使用多变量线性回归的预孢子静脉渗透液推注和每个标记的相对变化之间的风险调整的关联。结果：345名患者中，88名（26％）接受了一次性IV液体推注和257（74％）没有。与未接收到预孢子液的患者相比，最初在接受预孢子静脉液体推注（22.3 [IQR 6.4-113]与11.5 [IQR 5.5-47.6]）的受试者中，中位前IL-6更大。在两组（IL-10：3.5 [IQR 2.2-25.6]中，Prehospital IL-10和TNF相似; 3.0 [IQR 1.9-9]; TNF：7.5 [IQR 6.4-10.4]与6.9 [IQR 6.0-8.3 ]）。在调整人口统计学，疾病严重程度和先前运输时间后，我们观察到在接受预孢子液推注的人中IL-6的相对降低（调整β= -10.0,95％CI：-19.4，-0.6，P = 0.04），但我们没有检测到IL-10的显着变化（P = 0.34）或TNF（P = 0.53）。结论：在非创伤中，非心脏病患者对危重疾病的风险，一种预孢子术IV液体推注与IL-6的相对降低有关，但不是IL-10或TNF。

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