Assessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock

Kiracofe-Hoyte, Brittany R.; Doepker, Bruce; Riha, Heidi; Wilkinson, Rachel; Rozycki, Elizabeth; Adkins, Eric; Lehman, Amy; Berkel, Megan A. Van

doi:10.1016/j.jcrc.2020.09.006

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…Several retrospective studies have attempted to demonstrate the influence of weight on fluid administration and resuscitation-related outcomes. [33][34][35][36][37] While there were some differences in baseline comorbidities between BMI or weight-based groups in these investigations, there were no significant differences between groups with respect to severity scoring systems when calculated. One study published in 2010 evaluated the relationship between resuscitative patterns and organ function in a cohort of trauma patients.…”

Section: Bolus Fluid Dosing In Obesitymentioning

confidence: 74%

“…In another study published in 2021, the time to hemodynamic stability was evaluated in a study of obese patients (BMI ≥30 kg/m 2 ) with septic shock stratified by the dose of fluids administered, <30 mL/kg or ≥ 30 mL/kg using TBW. 36 The actual volume of fluids administered were 2 L and 3.5 L, which translates to 16 mL/kg and 37 mL/kg, respectively, when indexed to TBW. After adjusting for several confounding variables, provision of ≥30 mL/kg was associated with a shorter time to hemodynamic stability and lower odds of in-hospital death.…”

Section: Bolus Fluid Dosing In Obesitymentioning

confidence: 99%

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Challenges With Using a Weight-Based Approach to Bolus Fluid Dosing in Obese Critically Ill Patients

Erstad

Barletta

2022

Ann Pharmacother

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At least 30 mL/kg of crystalloid fluid administration within the first 3 hours of resuscitation is suggested by the current Surviving Sepsis Campaign guidelines for management of sepsis and septic shock. This commentary discusses the challenges with using a weight-based approach to bolus fluid dosing during the early phase of resuscitation of adult, obese patients. Based on the available literature, arguments can be made for the use of either ideal or adjusted body weight for weight-based fluid dosing, but there are concerns with fluid overload if using actual body weight to dose patients with more severe forms of obesity.

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Section: Bolus Fluid Dosing In Obesitymentioning

confidence: 74%

Section: Bolus Fluid Dosing In Obesitymentioning

confidence: 99%

Challenges With Using a Weight-Based Approach to Bolus Fluid Dosing in Obese Critically Ill Patients

Erstad

Barletta

2022

Ann Pharmacother

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“…Therefore, it is essential to achieve accurate fluid management during resuscitation. 10,11 PiCCO is a clinically common tool to transform pressure monitoring into volume monitoring and support data generation without massive invasion. 12 This study showed that at 6 h after resuscitation, DBP, MAP, SBP, and CVP were substantially increased in both groups when compared with the preresuscitation levels; the two groups did not differ in DBP, MAP, SBP, or CVP at 6 h after resuscitation.…”

Section: A H E a D O F P R I N Tmentioning

confidence: 99%

The role of pulse indicator continuous cardiac output (PiCCO) and critical care ultrasound in volume status assessment during fluid resuscitation for and prognosis of septic shock patients

Luo¹,

Zhan

Zhu³

et al. 2022

Pak J Med Sci

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Objectives: To investigate whether pulse index continuous cardiac output (PiCCO) and critical care ultrasound are highly consistent in volume status assessment during fluid resuscitation for septic shock patients and analyze their influence on the prognosis of septic shock. Methods: Eighty septic shock patients treated by Huizhou Central People’s Hospital during December 2018 and December 2020 were included and divided into a study group and a control group by the presence of volume responsiveness, with each group having 40 patients. The control group was subject to PiCCO-guided fluid resuscitation therapy, while the study group was given fluid resuscitation therapy guided by critical care ultrasound. Cardiac output, cardiac function, and catheter-related infection (CRI) were documented for intergroup comparison to confirm whether these two techniques were consistent with each other regarding their effects on resuscitation for and prognosis of septic shock patients. Results: Mechanical ventilation duration (MVD) and intensive care unit (ICU) length of stay (LoS) were significantly shorter in the study group when compared with the control group, and the differences were statistically significant (p<0.05, respectively). In terms of blood pressure parameters, the two groups did not differ greatly in diastolic blood pressure (DBP), mean arterial pressure (MAP), systolic blood pressure (SBP), and central venous pressure (CVP) before resuscitation (p>0.05, respectively); at 6h(six hour) after resuscitation, DBP, MAP, SBP, and CVP were substantially increased in both groups as compared with the pre-resuscitation levels (all p<0.05), but the differences between the two groups lacked statistical significance (all p>0.05). Comparing urine volume and degrees of positive fluid balance at 6 h and 12 h after resuscitation, drastic increases in urine volume and positive fluid balance were observed in both groups at 12 h as compared with at 6 h (all p<0.05); nevertheless, the two groups showed no statistically significant difference in urine volume and positive fluid balance at 6 h or 12 h (p>0.05, respectively). With regards to prognosis, there was no statistically significant difference between the two groups in the number of cases of continuous renal replacement therapy (CRRT), dosage of vasoactive agents and 28-d mortality rate (all p>0.05). However, the incidence of CRI was markedly lower in the study group (0/40) as compared with the control group (5/40), and the difference was statistically significant (p<0.05). Conclusions: Both PiCCO and critical care ultrasound can help achieve favorable outcomes from resuscitation for septic shock patients. Compared with PiCCO, critical care ultrasound monitoring appears to be more effective in preventing CRI and reducing MVD and ICU LoS, thereby easing patients’ medical burden. doi: https://doi.org/10.12669/pjms.39.1.5603 How to cite this: Luo Y, Zhan S, Zhu L, Xiong M, Liu G, Wang C. The role of pulse indicator continuous cardiac output (PiCCO) and critical care ultrasound in volume status assessment during fluid resuscitation for and prognosis of septic shock patients. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.5603 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sepsis in Special Populations

Baldisseri¹,

Johnson²,

Mazzei³

et al. 2023

The Sepsis Codex

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Assessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock

Cited by 3 publications

References 27 publications

Challenges With Using a Weight-Based Approach to Bolus Fluid Dosing in Obese Critically Ill Patients

Challenges With Using a Weight-Based Approach to Bolus Fluid Dosing in Obese Critically Ill Patients

The role of pulse indicator continuous cardiac output (PiCCO) and critical care ultrasound in volume status assessment during fluid resuscitation for and prognosis of septic shock patients

Sepsis in Special Populations

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