FACTORS ASSOCIATED WITH FLUID BALANCE IN SEPSIS AND SEPTIC SHOCK

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: The use of fluids in the management of sepsis is considered a strong recommendation with little evidence to support its use. In recent years, a significant amount of attention has been given to fluid balance over the course of sepsis management and multiple studies have identified correlations between positive fluid balance and increased morbidity and mortality. Our goal is to study mortality and clinical comorbidities that may be associated with having a positive fluid balance in sepsis recovery. METHODS: We performed a retrospective chart review of all patients discharged with a diagnosis of sepsis, severe sepsis or septic shock in 2018 from the 30-bed Medical Intensive Care Unit of Dell Seton Medical Center at the University of Texas at Austin, a Level I Trauma Center and teaching hospital for Dell Medical School. Adult patients admitted to the unit directly from the emergency room were included. We used descriptive statistics to characterize this population, and Fisher’s exact test to compare the proportion of deaths and clinical comorbidities between patients with a positive vs negative fluid balance. The study received IRB approval from the University of Texas at Austin. RESULTS: A total of 24 patients from 170 reviewed charts met inclusion criteria. Mean age of the patients was 58.8 years and 45% were male. Average ICU length of stay was 5.8 days and average ventilator days was 1.73 days. A total of 17% of patients died during ICU admission (N=4). A total of 16 (67%) patients had a positive fluid balance and 8 (33%) had a negative fluid balance. All 4 deaths were in the positive fluid balance group, however the proportion of deaths was not significantly different from the negative fluid balance group (positive: 4/16, negative 0/8, P>0.05). Proportions of CHF, cirrhosis, and ESRD were not different between fluid balance groups (CHF: 3/16 vs 2/8; cirrhosis: 4/16 vs 1/8; ESRD 0/16 vs 2/8; all P>0.05). CONCLUSIONS: The majority of patients admitted to the ICU for sepsis, severe sepsis, or septic shock ended up having a positive fluid balance, and although not statistically significant, there was a higher proportion of death among patients with a positive fluid balance. Further chart review of the 1100 total charts will focus on developing a larger sample size for outcomes analysis including mortality and potential effects of fluid balance on ICU length of stay, ventilator days, organ functionality, laboratory data and clinical comorbidities. CLINICAL IMPLICATIONS: This retrospective study shows that patients discharged from the ICU are on average net fluid positive and will further reveal how fluid balance affects multiple clinical parameters in recovery from sepsis. DISCLOSURES: No relevant relationships by Liwayway Andrade, source=Web Response No relevant relationships by Michael Castellarin, source=Web Response No relevant relationships by Andrea Fekete, source=Web Response No relevant relationships by Oscar Garcia, source=Web Response No relevant relationships by pranay kappera, source=Web Response No relevant relationships by Kanza Muzaffar, source=Web Response No relevant relationships by Zachary Pinchover, source=Web Response No relevant relationships by Koonj Shah, source=Web Response No relevant relationships by John Suder, source=Web Response No relevant relationships by Mohi Syed, source=Web Response No relevant relationships by Victoria Valencia, source=Web Response