Fluid resuscitation in severe sepsis and septic shock: An evidence-based review

Vincent, Jean‐Louis; Gerlach, Herwig

doi:10.1097/01.ccm.0000142984.44321.a4

Cited by 151 publications

(81 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17,18 Six to 10 L of fluid may be administered in the first 24 hr of management. 5 Indeed, in the Rivers' goal directed resuscitation trial of septic shock, patients in the goal directed group received a mean of 5.0 (± SD 3.0) as compared to 3.5 (± SD 2.4) L of fluid in the standard therapy arm in just the first six hours of care.…”

Section: Discussionmentioning

confidence: 99%

“…Despite decades of research, there is still a lack of evidence in specific critically ill patient populations to help guide the clinician as to the optimal choice of resuscitation fluid. 18 Results of the SAFE trial have resolved some of the colloid-crystalloid controversy because investigators found no difference in 28-day mortality between the 4% albumin and normal saline study groups. 15 However, a severe sepsis subgroup analysis of 1,219 patients found a trend toward a reduction in 28-day mortality for the albumin as compared to normal saline group (relative risk ratio of 0.87, 95% CI 0.74 to 1.02) 15 suggesting the possibility for benefit in this specific critically ill patient population.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Background: Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. Methods:A retrospective, multicentre cohort study was undertaken at five Canadian tertiary care ICUs. We identified patients with severe sepsis admitted to the ICU between July 1, 2000, and June 30, 2002, using both administrative and clinical databases. Patients were included if they were hypotensive, had an infectious source, and at least two systemic inflammatory response syndrome criteria. We recorded total quantity and type of fluid administered for the first six hours after severe sepsis was identified. The first episode of hypotension defined the starting point for collection of fluid data. Multivariable regression analyses were performed to examine associations between quantity and type of fluid administered and hospital/ICU mortality, and organ failure.Results: Of 2,026 potentially eligible patient charts identified, 496 patients met eligibility criteria. The mean age and Acute Physiology and Chronic Health Evaluation score (APACHE II) were 61.8 ± 16.5 yr and 29.0 ± 8.0, respectively. No associations between quantity or type of fluid administered and hospital mortality or ICU mortality were identified, and there were no statistically significant associations between quantity or type of fluid administered and organ failure. However, more fluid resuscitation was associated with an increased risk of cardiovascular failure [odds ratio (OR) and 95% confidence interval Conclusion:An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Patients under treatment, even when appropriate, after multiple organ dysfunction have a worse prognosis. (13,14,(25)(26)(27)(28) There is evidence that therapeutic intervention with hemodynamic resuscitation and antibiotic therapy are associated to lower mortality rates. (7)(8)(9)(10)(11)(12)15) As such, agile and adequate treatment is the "mainstay" for a successful approach to severe sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…The basis of this strategy is to (45) 14 (42) 19 (57) 26 (47) 29 (53) 30 (65) 16 (35) 8 (35) 30.8 ± 54.7 14.5 ± 9.1 29.7 ± 36.4 11.3 ± 9.8 9.6 ± 8. treat overall tissue hypoxia as fast as possible to revert the unbalance between offer and consumption of oxygen to avoid development of MOD. (13,(26)(27)(28) Furthermore, control of the infection focus, with broad spectrum antibiotics and/or surgical drainage in the first hours after diagnosis, also has a major impact on prognosis. (9,10) All patients cared in the first stage of this study were treated according to SSC guidelines.…”

Section: Discussionmentioning

confidence: 99%

Estratégia de detecção precoce e redução de mortalidade na sepse grave

Westphal¹,

Feijó²,

Andrade³

et al. 2009

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

Objective: To evaluate the impact of implementing an institutional policy for detection of severe sepsis and septic shock.Methods: Study before (stage I), after (stage II) with prospective data collection in a 195 bed public hospital.. Stage I: Patients with severe sepsis or septic shock were included consecutively over 15 months and treated according to the Surviving Sepsis Campaign guidelines. Stage II: In the 10 subsequent months, patients with severe sepsis or septic shock were enrolled based on an active search for signs suggesting infection (SSI) in hospitalized patients. The two stages were compared for demographic variables, time needed for recognition of at least two signs suggesting infection (SSIΔt), compliance to the bundles of 6 and 24 hours and mortality.Results: We identified 124 patients with severe sepsis or septic shock, 68 in stage I and 56 in stage II. The demographic variables were similar in both stages. The Δt-SSI was 34 ± 54 hours in stage I and 7 ± 8.4 hours in stage II (p <0.001). There was no difference in compliance to the bundles. In parallel there was significant reduction of mortality rates at 28 days (54.4% versus 30%, p <0.02) and hospital (67.6% versus 41%, p <0.003). Conclusion: The strategy used helped to identify early risk of sepsis and resulted in decreased mortality associated with severe sepsis and septic shock.

show abstract

“…Como ainda não existem evidências que indiquem a utilização de colóides em detrimento a cristalóides ambos podem ser utilizados no dia a dia de uma UTI (14).…”

Section: Introductionunclassified

Mecanismos de hipoperfusão tecidual na sepse experimental e efeitos da reposição volêmica com solução salina hipertônica-isoncótica e pentoxifilina

Dias¹

View full text Add to dashboard Cite

Fluid resuscitation in severe sepsis and septic shock: An evidence-based review

Abstract: Fluid resuscitation of severe sepsis may consist of natural or artificial colloids or crystalloids. Fluid challenge should be administered and repeated based on response (increase in blood pressure and urine output) and tolerance (evidence of intravascular volume overload).

Cited by 151 publications

References 27 publications

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

Réanimation des patients en début de sepsie sévère: Une étude observationnelle multi-centrique canadienne

Estratégia de detecção precoce e redução de mortalidade na sepse grave

Mecanismos de hipoperfusão tecidual na sepse experimental e efeitos da reposição volêmica com solução salina hipertônica-isoncótica e pentoxifilina

Contact Info

Product

Resources

About