Abstract
PurposeFluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient characteristics and fluid resuscitation volumes in ICU patients with severe sepsis.MethodsWe explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer’s acetate. Our primary outcome measure was fluid resuscitation volume and secondary outcome total fluid input administered from 24 hours before randomisation until the end of day 3 post-randomisation. We performed multivariate analyses with hospital and patient baseline characteristics as covariates to assess associations with fluid volumes given.ResultsWe included 654 patients who were in the ICU for 3 days and had fluid volumes available. Individual trial sites administered significantly different volumes of fluid resuscitation and total fluid input after adjusting for baseline variables (P<0.001). Increased lactate, higher cardiovascular and renal SOFA subscores, lower respiratory SOFA subscore and surgery were all independently associated with increased fluid resuscitation volumes.ConclusionsHospital characteristics adjusted for patient baseline values were associated with differences in fluid resuscitation volumes given in the first 3 days of severe sepsis. The data indicate variations in clinical practice not explained by patient characteristics emphasizing the need for RCTs assessing fluid resuscitation volumes fluid in patients with sepsis.
Highlights
For decades fluid resuscitation has been considered a pivotal intervention in the treatment of patients with sepsis and circulatory impairment
Higher cardiovascular and renal Sequential Organ Failure Assessment (SOFA) subscores, lower respiratory SOFA subscore and surgery were all independently associated with increased fluid resuscitation volumes
Hospital characteristics adjusted for patient baseline values were associated with differences in fluid resuscitation volumes given in the first 3 days of severe sepsis
Summary
For decades fluid resuscitation has been considered a pivotal intervention in the treatment of patients with sepsis and circulatory impairment. Fluid resuscitation guided by central venous pressure in the first six hours of septic shock was a part of the protocol in the landmark trial of Early Goal-Directed Therapy (EGDT) in sepsis by Rivers et al that showed significantly increased survival with EGDT [6]. Beyond the first six hours the international guidelines for fluid resuscitation are vague and ungraded due to lack of evidence; the 2012 recommendation for continued fluid therapy from the Surviving Sepsis Campaign states: “Fluid challenge technique be applied wherein fluid administration is continued as long as there is hemodynamic improvement either based on dynamic (e.g. change in pulse pressure, stroke volume variation) or static (e.g. arterial pressure, heart rate) variables” [11]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
