The Effect of Fluid Resuscitation Timing in Early Sepsis Resuscitation.
J Intensive Care Med
; 38(11): 1051-1059, 2023 Nov.
Article
en En
| MEDLINE
| ID: mdl-37287235
ABSTRACT
PURPOSE:
The dose and timing of early fluid resuscitation in sepsis remains a debated topic. The objective of this study is to evaluate the effect of fluid timing in early sepsis management on mortality and other clinical outcomes.METHODS:
Single-center, retrospective cohort study of emergency-department-treated adults (>18 years, n = 1032) presenting with severe sepsis or septic shock. Logistic regression evaluating the impact of 30â mL/kg crystalloids timing and mortality-versus-time plot controlling for mortality in emergency department sepsis score, lactate, antibiotic timing, obesity, sex, systemic inflammatory response syndrome criteria, hypotension, and heart and renal failures. This study is a subanalysis of a previously published investigation.RESULTS:
Mortality was 17.1% (n = 176) overall and 20.4% (n = 133 of 653) among those in septic shock. 30â mL/kg was given to 16.9%, 32.2%, 16.2%, 14.5%, and 20.3% of patients within ≤1, 1 ≤ 3, 3 ≤ 6, 6 ≤ 24, and not reached within 24â h, respectively. A 24-h plot of adjusted mortality versus time did not reach significance, but within the first 12â h, the linear function showed a per-hour mortality increase (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.02-1.67) which peaks around 5h, although the quadratic function does not reach significance (P = .09). When compared to patients receiving 30â mL/kg within 1â h, increased mortality was observed when not reached within 24â h (OR 2.69, 95% CI 1.37-5.37) but no difference when receiving this volume between 1 and 3 (OR 1.11, 95% CI 0.62-2.01), 3 and 6 (OR 1.83, 95% CI 0.97-3.52), or 6 and 24â h (OR 1.51, 95% CI 0.75-3.06). Receiving 30â mL/kg between 1 and 3 versus <1â h increased the incidence of delayed hypotension (OR 1.83, 95% CI 1.23-2.72) but did not impact need for intubation, intensive care unit admission, or vasopressors.CONCLUSIONS:
We observed weak evidence that supports that earlier is better for survival when reaching fluid goals of 30â mL/kg, but benefits may wane at later time points. These findings should be viewed as hypothesis generating.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Choque Séptico
/
Sepsis
/
Hipotensión
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Adult
/
Humans
Idioma:
En
Revista:
J Intensive Care Med
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Estados Unidos