Abstract
BackgroundThe use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data.MethodsThe retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation.ResultsThe use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82–0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93–1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90–0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus.ConclusionThe use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.
Highlights
More than fifty percent of the patients with sepsis, severe sepsis (SeS), or septic shock (SS) used to die before the widespread implementation of early goal-directed therapy (EGDT) recommended by surviving sepsis campaign (SSC) in 2001 [1,2,3]
The use of 30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data
The use of 30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% confidence interval (CI) 0.90–0.99, (p
Summary
More than fifty percent of the patients with sepsis, severe sepsis (SeS), or septic shock (SS) used to die before the widespread implementation of early goal-directed therapy (EGDT) recommended by surviving sepsis campaign (SSC) in 2001 [1,2,3]. The patient-level meta-analysis of three trials done confirmed the finding, but the amount of fluid used in both EGDT and usual care patients was around 28 mL/Kg (~2L) before the patients were randomized, which was very close to the initial fluid bolus of 30 mL/Kg recommended by SSC guidelines [5]. Since the Rivers et al [2] did their randomized controlled trial (RCT) on EGDT in 2001, it broke the taboo of SeS and SS as “Intensive Care Unit (ICU) disease,” and patients got aggressive fluid resuscitation from the very beginning in addition to usual care, which decreased the mortality worldwide [3]. The use of 30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data
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