Effects of High versus Low Volume of Initial Fluid Resuscitation of Emergency Department Patients with Sepsis and Septic Shock
Keywords:
Septic shock, Sepsis with tissue hypoperfusion, Fluid resuscitation, Emergency department, MortalityAbstract
Background and Objective: Fluid administration is the cornerstone treatment in sepsis patients. According to the surviving sepsis campaign guideline suggests an initial fluid 30ml/kg in the first 3 hours for resuscitation; however no clear evidence of the benefits of this suggestion. The objective of this study is to evaluate the effect of fluid resuscitation during admitted in the emergency department (ED) in sepsis with tissue hypoperfusion or septic shock patients and hospital mortality.
Methods: This is a retrospective cohort study of adult patients with sepsis induced tissue hypoperfusion or septic shock who visited the emergency department. The enrolled patients were divided into high volume fluid resuscitation group (≥30ml/Kg) and low volume fluid resuscitation group (<30ml/Kg) according to total fluid resuscitation during admitted in the ED. The primary outcome was in hospital mortality. Multivariable logistic regression and Kalan-Meier graph were used to analyze the outcome of the study.
Results: A total of 355 patients were enrolled into the study, 159 patients were in high volume fluid resuscitation group and 196 patients were in low volume fluid resuscitation group. Thirty-nine patients in high volume fluid resuscitation group and sixty patients in low volume fluid resuscitation group were dead. Multivariable logistic regression showed no association of high volume fluid resuscitation and survival benefit in sepsis with tissue hypoperfusion or septic shock patients AOR 0.59 (0.35-1.02) p= 0.056.
Conclusions: In sepsis with tissue hypoperfusion or septic shock patients, high volume of fluid resuscitation was not associated with decreased hospital mortality.
References
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181-247. doi:10.1007/s00134-021-06506-y.
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018;44(6):925-8. doi:10.1007/s00134-018-5085-0
ProCESS Investigators; Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014;370(18):1683-93. doi:10.1056/NEJMoa1401602.
ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014;371(16):1496-506. doi:10.1056/NEJMoa1404380.
Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. ProMISe Trial Investigators. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015;372(14):1301-11. doi:10.1056/NEJMoa1500896.
Acharya R, Patel A, Schultz E, Bourgeois M, Kandinata N, Paswan R, et al. Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: a retrospective case-control study. PLoS One 2021;16(8):e0256368. doi:10.1371/journal.pone.0256368.
Matsuda W, Funato Y, Miyazaki M, Tomiyama K. Fluid resuscitation of at least 30 ml/kg was not associated with decreased mortality in patients with infection, signs of hypoperfusion, and a do-not-intubate order. Acute Med Surg 2022;9(1):e795. doi:10.1002/ams2.795.
Wang HL, Shao J, Liu WL, Wu F, Chen HB, Zheng RQ, et al. Initial fluid resuscitation (30 ml/kg) in patients with septic shock: more or less? Am J Emerg Med 2021;50:309-15. doi:10.1016/j.ajem.2021.08.016.
Lee SJ, Ramar K, Park JG, Gajic O, Li G, Kashyap R. Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study. Chest 2014;146(4):908-15. doi:10.1378/chest.13-2702.
Hu B, Chen JCY, Dong Y, Frank RD, Passe M, Portner E, et al. Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study. Crit Care 2020;24(1):137. doi:10.1186/s13054-020-2819-5.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801-10. doi:10.1001/jama.2016.0287.
Al Aseri Z. Assessment and management of hypoperfusion in sepsis and septic shock [Internet]. Infections and Sepsis Development. IntechOpen; 2021. [cited 5 May 2023]. Available from: http://dx.doi.org/10.5772/intechopen.98876
Jones AE, Puskarich MA. Sepsis-induced tissue hypoperfusion. Crit Care Clin 2009;25(4):769-79, ix. doi:10.1016/j.ccc.2009.06.003.
Bernard, R. Fundamentals of biostatistics. 5thed. Duxbery: Thomson learning; 2000.
Semler MW, Rice TW. Sepsis resuscitation: fluid choice and dose. Clin Chest Med 2016;37(2):241-50. doi:10.1016/j.ccm.2016.01.007.
Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369(9):840-51. doi:10.1056/NEJMra1208623.
Yohannes S, Serafim LP, Slavinsky V, O'Connor T, Cabrera M, Chin MK, et al. Evaluation of the recommended 30 cc/kg fluid dose for patients with septic shock and hypoperfusion with lactate greater than 4 mmol/L. Crit Care Explor 2023;5(7):e0932. doi:10.1097/CCE.0000000000000932.
Acheampong A, Vincent JL. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 2015;19(1):251. doi:10.1186/s13054-015-0970-1.
Zheng R, Jin X, Liao W, Lin L. Association between the volume of fluid resuscitation and mortality modified by disease severity in patients with sepsis in ICU: a retrospective cohort study. BMJ Open 2023;13(4):e066056. doi:10.1136/bmjopen-2022-066056.
Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early use of norepinephrine in septic shock resuscitation (CENSER). A randomized trial. Am J Respir Crit Care Med 2019;199(9):1097-105. doi:10.1164/rccm.201806-1034OC.
Monnet X, Lai C, Teboul JL. How I personalize fluid therapy in septic shock? Crit Care 2023;27(1):123. doi:10.1186/s13054-023-04363-3.
Moschopoulos CD, Dimopoulou D, Dimopoulou A, Dimopoulou K, Protopapas K, Zavras N, et al. New insights into the fluid management in patients with septic shock. Medicina (Kaunas) 2023;59(6):1047. doi:10.3390/medicina59061047.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Srinagarind Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
