Adherence to fluid resuscitation guidelines and outcomes in patients with septic shock: Reassessing the “one-size-fits-all” approach

Abstract

ObjectiveThe Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality. DesignRetrospective, observational study. Setting1136-bed academic and 235-bed community hospital (January 2015–June 2016). PatientsPatients with septic shock. InterventionsCrystalloid infusion (≥30 mL/kg) within 6 h of identification of septic shock as required by CMS. MeasurementsAssociations with compliance and how compliance associates with mortality; odds ratios (OR) and 95% confidence intervals (CI) reported. Main resultsOverall, 1027 septic shock patients were included. Of these, 486 (47.3%) met the 6-hour 30 ml/kg fluid requirement. Compliance was lower in patients with congestive heart failure (CHF) (40.9%), chronic kidney disease (CKD) (42.3%) or chronic liver disease (38.5%) and among those that were identified in the inpatient setting (35.4%) rather than in the emergency department (51.7%). When adjusting for relevant covariates, compliance (compared to non-compliance) was not associated with in-hospital mortality: OR 1.03 CI 0.76–1.41. ConclusionsThese findings question a “one-size-fits-all” approach to fluid administration and performance measures for patients with sepsis.