Stewart's Approach for Acid-base Disorders: Does the Strong Ion Difference and Effects Have an Impact on Intensive Care Unit Mortality?
Objective:The diagnosis and treatment of electrolyte and acid-base imbalances in intensive care unit (ICU) patients have critical importance. The value of Stewart's approach in revealing acid-base disorders is known. There are parameters defined according to this approach. This study investigat...
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| Main Authors: | , , , , , |
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| Format: | Book |
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Galenos Yayinevi,
2023-03-01T00:00:00Z.
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| Summary: | Objective:The diagnosis and treatment of electrolyte and acid-base imbalances in intensive care unit (ICU) patients have critical importance. The value of Stewart's approach in revealing acid-base disorders is known. There are parameters defined according to this approach. This study investigates the impact of the chloride effect (ClEffect), sodium effect (NaEffect), sodium-chloride effect (Na-ClEffect), strong ion difference (SIDnl) and Cl/Na ratio values calculated according to Stewart's approach on ICU mortality.Materials and Methods:Two thousand patients whose Na, Cl, K, standard base excess (SBE), pH values were recorded and SIDnl, ClEffect, NaEffect, Na-ClEffect, Acute Physiology Assessment and Chronic Health Evaluation-II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) scores calculated are included in this study. ClEffect, NaEffect, Na-ClEffect, SIDnl, Cl/Na ratio values were evaluated with a multivariable logistic regression model in terms of ICU mortality.Results:Abnormal ranges of SIDnl (SIDnl <30 or SIDnl ≥43) were significantly increased in non-survivors than survivors (p=0.026). ClEffect, NaEffect, Na-ClEffect, Cl/Na ratio and their percentages of abnormal ranges were similar between survivor and non-survivor patients.In the multivariate logistic regression model, the likelihood of mortality was 3.5-fold (2.9-4.3), 1.7-fold (1.4-2.1) and 1.2-fold (1.0-1.5) increased by APACHE-II ≥26, SOFA >7, and SIDnl <30 or SIDnl ≥43 (p<0.001, p<0.001, p=0.041, respectively).Conclusion:SIDnl is associated with ICU mortality, but pH, SBE, ClEffect, NaEffect, Na-ClEffect and Cl/Na ratio is not. SIDnl is one of the independent variables of Stewart's approach and is a valuable parameter in blood gas evaluations. |
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| Item Description: | 2146-6416 2147-267X 10.4274/tybd.galenos.2022.83007 |