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Cited by 176Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyAcute Kidney Injury Research

Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock

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Kuttab, Hani I., Lykins, Joseph D., Hughes, Michelle D., Wroblewski, Kristen, Keast, Eric P., Kukoyi, Omobolawa, Kopec, Jason A., Hall, Stephen +1 more·2019·Critical Care Medicine
DOI 10.1097/ccm.0000000000003960PMC PMC8096207
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Abstract

Objectives: Rapid fluid resuscitation has become standard in sepsis care, despite “low-quality” evidence and absence of guidelines for populations “at risk” for volume overload. Our objectives include as follows: 1) identify predictors of reaching a 30 mL/kg crystalloid bolus within 3 hours of sepsis onset (30by3); 2) assess the impact of 30by3 and fluid dosing on clinical outcomes; 3) examine differences in perceived “at-risk” volume-sensitive populations, including end-stage renal disease, heart failure, obesity, advanced age, or with documentation of volume “overload” by bedside examination. Design: Retrospective cohort study. All outcome analyses controlled for sex, end-stage renal disease, heart failure, sepsis severity (severe sepsis vs septic shock), obesity, Mortality in Emergency Department Sepsis score, and time to antibiotics. Setting: Urban, tertiary care center between January 1, 2014, and May 31, 2017. Patients: Emergency Department treated adults (age ≥18 yr; n = 1,032) with severe sepsis or septic shock. Interventions: Administration of IV fluids by bolus. Measurements and Main Results: In total, 509 patients received 30by3 (49.3%). Overall mortality was 17.1% (n = 176), with 20.4% mortality in the shock group. Patients who were elderly (odds ratio, 0.62; 95% CI, 0.46–0.83), male (odds ratio, 0.66; CI, 0.49–0.87), obese (odds ratio, 0.18; CI, 0.13–0.25), or with end-stage renal disease (odds ratio, 0.23; CI, 0.13–0.40), heart failure (odds ratio, 0.42; CI, 0.29–0.60), or documented volume “overload” (odds ratio, 0.30; CI, 0.20–0.45) were less likely to achieve 30by3. Failure to meet 30by3 had increased odds of mortality (odds ratio, 1.52; CI, 1.03–2.24), delayed hypotension (odds ratio, 1.42; CI, 1.02–1.99), and increased ICU stay (~2 d) (β = 2.0; CI, 0.5–3.6), without differential effects for “at-risk” groups. Higher fluid volumes administered by 3 hours correlated with decreased mortality, with a plateau effect between 35 and 45 mL/kg (p < 0.05). Conclusions: Failure to reach 30by3 was associated with increased odds of in-hospital mortality, irrespective of comorbidities. Predictors of inadequate resuscitation can be identified, potentially leading to interventions to improve survival. These findings are retrospective and require future validation.

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  • Failure to receive 30 ml/kg crystalloid within 3 h of sepsis onset in ED patients with sepsis or septic shock was associated with increased odds of in-hospital mortality, irrespective of comorbidities including end-stage kidney disease and heart failure.

    “A retrospective analysis of adults presenting to an emergency department with sepsis or septic shock showed that failure to receive 30 ml/kg of crystalloid fluid therapy within 3 h of sepsis onset was associated with increased odds of in-hospital mortality, delayed resolution of hypotension and increased length of stay in ICU, irrespective of comorbidities, including end-stage kidney disease and”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [63]

  • Failure to receive 30 ml/kg crystalloid within 3 h was associated with delayed resolution of hypotension and increased ICU length of stay.

    “failure to receive 30 ml/kg of crystalloid fluid therapy within 3 h of sepsis onset was associated with increased odds of in-hospital mortality, delayed resolution of hypotension and increased length of stay in ICU”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [63]

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Research works printed but not linked: 2

  1. [16]Akhter M, Hallare M, Roontiva A,: Fluid Resuscitation of Septic Patients at Risk for Fluid Overload. Ann Emerg Med 2017; 70: S61– S62
  2. [20]Duttuluri M, Rose K, Shapiro J,: Fluid Resuscitation Dilemma in Patients with Congestive Heart Failure Presenting with Severe Sepsis/Septic Shock [Internet]. In: D45. CRITICAL CARE: CIRCULATORY HEMODYMANICS, SHOCK, CARDIOVASCULAR DISEASE, AND FLUID MANAGEMENT. American Thoracic Society; 2016. p. A7048– A7048. Available from: 10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A7048 · DOI

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Authors
Kuttab, H. I., Lykins, J. D., Hughes, M. D., Wroblewski, K., Keast, E. P., Kukoyi, O., Kopec, J. A., Hall, S., & Ward, M. A.
Affiliations
  • University of Chicago Medical Center (US)
  • Department of Emergency Medicine and Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA.
  • University of Chicago (US)
  • University of Wisconsin–Madison (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-11
Volume
47
Issue
11
Pages
1582-1590
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0000000000003960
PMC
PMC8096207
OpenAlex
W2967525737
Cited by
176
References
33
Citations by year
2026: 20 · 2025: 40 · 2024: 33 · 2023: 25 · 2022: 23 · 2021: 22 · 2020: 13
FWCI
11.03
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR002389)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords
severe sepsis, septic shock, fluid resuscitation, fluid overload, mortality, end-stage renal disease, heart failure, obesity, elderly patients, timing of antibiotic administration, sepsis severity
MeSH terms
Age Factors, Emergency Service, Hospital, Female, Fluid Therapy, Humans, Intensive Care Units, Kidney Failure, Chronic, Male, Middle Aged, Patient Admission, Resuscitation, Retrospective Studies, Sex Factors, Shock, Septic, Cohort Studies, Comorbidity, Hospital Mortality, Sepsis

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