Josep-Maria Sirvent1, Cristina Ferri2, Anna Baró3, Cristina Murcia3, Carolina Lorencio3. 1. Department of Intensive Care (ICU), University Hospital of Girona Doctor Josep Trueta, IDIBGI, CIBERES, Girona, Spain. Electronic address: jsirvent.girona.ics@gencat.cat. 2. Department of Intensive Care (ICU), University Hospital of Tarragona Joan XXIII, Tarragona, Spain. 3. Department of Intensive Care (ICU), University Hospital of Girona Doctor Josep Trueta, IDIBGI, CIBERES, Girona, Spain.
Abstract
OBJECTIVE: The objective was to assess whether fluid balance had a determinant impact on mortality rate in a cohort of critically ill patients with severe sepsis or septic shock. DESIGN: A prospective and observational study was carried out on an inception cohort. SETTING: The setting was an intensive care unit of a university hospital. PATIENTS: Patients admitted consecutively in the intensive care unit who were diagnosed with severe sepsis or septic shock were included. INTERVENTIONS: Demographic, laboratory, and clinical data were registered, as well as time of septic shock onset, illness severity (Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment), and comorbidities. Daily and accumulated fluid balance was registered at 24, 48, 72, and 96 hours. Survival curves representing 28-day mortality were built according to the Kaplan-Meier method. RESULTS: A total of 42 patients were included in the analysis: men, 64.3%; mean age, 61.8±15.9 years. Septic shock was predominant in 69% of the cases. Positive blood cultures were obtained in 17 patients (40.5%). No age, sex, Sepsis-related Organ Failure Assessment, creatinine, lactate, venous saturation of O2, and troponin differences were observed upon admission between survivors and nonsurvivors. However, higher Simplified Acute Physiology Score II was observed in nonsurvivors, P=.016. Nonsurvivors also showed higher accumulated positive fluid balance at 48, 72, and 96 hours with statistically significant differences. Besides, significant differences (P=.02) were observed in the survival curve with the risk of mortality at 72 hours between patients with greater than 2.5 L and less than 2.5 L of accumulated fluid balance. CONCLUSIONS: Fluid administration at the onset of severe sepsis or septic shock is the first line of hemodynamic treatment. However, the accumulated positive fluid balance in the first 48, 72, and 96 hours is associated with higher mortality in these critically ill patients.
OBJECTIVE: The objective was to assess whether fluid balance had a determinant impact on mortality rate in a cohort of critically illpatients with severe sepsis or septic shock. DESIGN: A prospective and observational study was carried out on an inception cohort. SETTING: The setting was an intensive care unit of a university hospital. PATIENTS: Patients admitted consecutively in the intensive care unit who were diagnosed with severe sepsis or septic shock were included. INTERVENTIONS: Demographic, laboratory, and clinical data were registered, as well as time of septic shock onset, illness severity (Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment), and comorbidities. Daily and accumulated fluid balance was registered at 24, 48, 72, and 96 hours. Survival curves representing 28-day mortality were built according to the Kaplan-Meier method. RESULTS: A total of 42 patients were included in the analysis: men, 64.3%; mean age, 61.8±15.9 years. Septic shock was predominant in 69% of the cases. Positive blood cultures were obtained in 17 patients (40.5%). No age, sex, Sepsis-related Organ Failure Assessment, creatinine, lactate, venous saturation of O2, and troponin differences were observed upon admission between survivors and nonsurvivors. However, higher Simplified Acute Physiology Score II was observed in nonsurvivors, P=.016. Nonsurvivors also showed higher accumulated positive fluid balance at 48, 72, and 96 hours with statistically significant differences. Besides, significant differences (P=.02) were observed in the survival curve with the risk of mortality at 72 hours between patients with greater than 2.5 L and less than 2.5 L of accumulated fluid balance. CONCLUSIONS: Fluid administration at the onset of severe sepsis or septic shock is the first line of hemodynamic treatment. However, the accumulated positive fluid balance in the first 48, 72, and 96 hours is associated with higher mortality in these critically illpatients.
Authors: Zhongheng Zhang; Nathan J Smischney; Haibo Zhang; Sven Van Poucke; Panagiotis Tsirigotis; Jordi Rello; Patrick M Honore; Win Sen Kuan; Juliet June Ray; Jiancang Zhou; You Shang; Yuetian Yu; Christian Jung; Chiara Robba; Fabio Silvio Taccone; Pietro Caironi; David Grimaldi; Stefan Hofer; George Dimopoulos; Marc Leone; Sang-Bum Hong; Mabrouk Bahloul; Laurent Argaud; Won Young Kim; Herbert D Spapen; Jose Rodolfo Rocco Journal: J Thorac Dis Date: 2016-09 Impact factor: 2.895
Authors: Paul E Marik; Walter T Linde-Zwirble; Edward A Bittner; Jennifer Sahatjian; Douglas Hansell Journal: Intensive Care Med Date: 2017-01-27 Impact factor: 17.440
Authors: Wesley H Self; Matthew W Semler; Rinaldo Bellomo; Samuel M Brown; Bennett P deBoisblanc; Matthew C Exline; Adit A Ginde; Colin K Grissom; David R Janz; Alan E Jones; Kathleen D Liu; Stephen P J Macdonald; Chadwick D Miller; Pauline K Park; Lora A Reineck; Todd W Rice; Jay S Steingrub; Daniel Talmor; Donald M Yealy; Ivor S Douglas; Nathan I Shapiro Journal: Ann Emerg Med Date: 2018-05-10 Impact factor: 5.721
Authors: Stephen P J Macdonald; Gerben Keijzers; David McD Taylor; Frances Kinnear; Glenn Arendts; Daniel M Fatovich; Rinaldo Bellomo; David McCutcheon; John F Fraser; Juan-Carlos Ascencio-Lane; Sally Burrows; Edward Litton; Amanda Harley; Matthew Anstey; Ashes Mukherjee Journal: Intensive Care Med Date: 2018-10-31 Impact factor: 17.440
Authors: Stephen P J Macdonald; David McD Taylor; Gerben Keijzers; Glenn Arendts; Daniel M Fatovich; Frances B Kinnear; Simon G A Brown; Rinaldo Bellomo; Sally Burrows; John F Fraser; Edward Litton; Juan Carlos Ascencio-Lane; Matthew Anstey; David McCutcheon; Lisa Smart; Ioana Vlad; James Winearls; Bradley Wibrow Journal: Trials Date: 2017-08-29 Impact factor: 2.279