Assessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock.

Abstract

Assess time to hemodynamic stability (HDS) in obese patients with septic shock who received <30 vs. ≥30ml/kg of initial fluid resuscitation based on actual body weight (ABW). Multicenter, retrospective, cohort analysis of 322 patients. Overall 216 (67%) patients received <30ml/kg of initial fluid resuscitation. Initial fluid received was lower in the <30ml/kg vs. ≥30ml/kg group (16 vs. 37ml/kg). The ≥30ml/kg group had shorter time to HDS (multivariable p=0.038) and lower riskof in-hospital death (multivariable p=0.038). An exploratory subgroup analysis (n=227) was performed, classifying patients by dosing strategy [ABW, adjusted body weight (AdjBW), ideal body weight (IBW)] based on fluid received at 3h divided by 30ml/kg. ABW dosed patients had a shorter time to HDS (multivariable p=0.013) and lower risk of in-hospital death (multivariable p=0.008) vs. IBW. Similar outcomes were observed between ABW vs. AdjBW. Obese patients given ≥30ml/kg based on ABW had a shorter time to HDS and a lower risk of in-hospital death. Exploratory results suggest improved outcomes resuscitating by ABW vs. IBW; ABW showed no strong benefit over AdjBW. Further prospective studies are needed to confirm the optimal fluid dosing in obese patients.