1070

Abstract

Introduction: Fluid resuscitation to a central venous pressure (CVP) goal of ≥ 8 is a key component in the early management of septic shock; however, there are no specific recommendations that address the amount of fluids and duration of time patients must be maintained at the targeted CVP goal. The purpose of this study was to determine if meeting a target CVP goal during the first six hours of severe sepsis and septic shock treatment had an impact on 28-day mortality. Methods: A single-center retrospective cohort analysis of critically ill adults who met criteria for severe sepsis or septic shock and had CVP recordings documented during the period from September 2011 to September 2012. Patients were identified as maintaining a CVP goal for ≥ 50% of the six-hour fluid resuscitation period or < 50% of the time. Maintaining a CVP goal was defined as having all measured CVP values between targets of 8-12 mm Hg or 12-15 mmHg in mechanically ventilated patients. The relationship between maintaining targeted CVP and mortality was analyzed using the Pearson's chi-square test. Results: A total of 256 adult ICU patients were eligible for study enrollment. 78 patients were included in the final analysis (12 CVP goal and 66 non-CVP goal). A total of 5 patients (42%) in the CVP goal group and 26 patients (39%) in the non-CVP goal group died within 28 days of their severe sepsis or septic shock event (p = 0.882). Non-survivors had a more positive fluid balance than survivors on days 1-3 (Day 1: 4071 mL vs. 1640 mL, respectively; p = 0.002; Day 2: 3473 mL vs. 1082 mL, p = 0.029; Day 3: 1090 mL vs. 59 mL, p = 0.004). Conclusions: There was no significant difference associated with 28-day mortality in patients who met CVP goal versus those that did not. The degree of fluid balance may have an impact on survival, and warrants further investigation.