The following is a summary of “Fluid balance control in critically ill patients: results from as-treated analyses of POINCARE-2 randomized trial,” published in the November 2023 issue of Critical Care by Mansouri et al.

POINCARE-2 trial’s intention-to-treat analysis provided inconclusive evidence on the impact of a conservative fluid balance strategy on critically ill patients’ mortality.

Researchers started a retrospective study to evaluate the impact of real-world implementation of the POINCARE-2 strategy on 60-day mortality in critically ill patients.

They conducted a stepped wedge randomized controlled trial called POINCARE 2. Patients eligible were those aged ≥ 18, on mechanical ventilation, and anticipated to stay in the ICU for over 24 hours. The POINCARE-2 method included 14-day daily weigh-ins, limiting fluid intake, utilizing diuretics, and/or ultrafiltration. A score was calculated from deviations, where patients scoring ≥ 75 were considered exposed to the strategy. Logistic regression adjusted for confounding variables (ALR) or an instrumental variable (IVLR) was utilized while missing data was managed using multiple imputations.

The results showed that of 1,361 patients in the control group, 24.8% had a score of exposure ≥ 75, while in the strategy group, it was 69.4%. Exposure to the POINCARE-2 strategy did not correlate with 60-day all-cause mortality (ALR: OR 1.2, 95% CI 0.85–1.55; IVLR: OR 1.0, 95% CI 0.76–1.33).

Investigators concluded that the direct implementation of the POINCARE-2 conservative strategy was not linked to reduced mortality in critically ill patients.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04701-5