Factors Associated with Altered Hydration Status among Critically Ill Adult Patients

Maintaining adequate hydration in critically ill patients is primary element of nursing
care. However, in critically ill patients, hydration is the missing part of nutritional care and
fluid balance disorders are relevant risk factors for morbidity and mortality in those patients.
Objective: The current study was conducted to identify factors associated with altered
hydration status among critically ill patients. Setting: This study was carried out at the
intensive care units (ICUs) of the Alexandria Main University Hospital, namely: the casualty
care unit and the general intensive care unit. Subjects: A convenience sample of 110 newly
admitted critically ill adult patients to the above mentioned settings were included in the
current study. Patients on hemodialysis or peritoneal dialysis and those with length of stay <3
days were excluded from this study. Tools: "Hydration Assessment tool" was used to collect
necessary data. Results: The result of current study showed that 68% of the studied sample
had fluid volume deficit. The most common factors associated with fluid volume deficit were
infection, hyperventilation, impaired skin integrity, unhumidified oxygen therapy, fever,
impaired swallowing and hyperglycemia were. While the most common factors associated
with fluid volume excess included renal insufficiency and use of steroids medications.
Conclusion: Fluid volume deficit is more common than fluid volume excess in the critically ill
patients. A significant relationship was found between patients' hydration status alterations
and their characteristics. Moreover, it can be concluded that keeping the body well hydrated
may seem to be a simple practice. However, it is very difficult, and the assessment of the
hydration status in the critically ill patients is challenging. Recommendations: Constant
monitoring of fluid intake and output should be done, all factors that contribute to hydration
status alterations should be considered and assessed continuously and all markers of
hydration should be integrated to identify patients' risk factors for fluid volume deficit or
excess.