Initial fluid resuscitation of patients with septic shock in the intensive care unit

Carlsen, Sarah; Perner, Anders

doi:10.1111/j.1399-6576.2011.02399.x

Cited by 19 publications

(16 citation statements)

References 18 publications

(15 reference statements)

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“…However, since a treatment is instituted because of a condition or an underlying disease it can be disputable to consider treatment per se as a risk factor. In line with a recent study, volume of resuscitation fluids and treatment with vasopressors were not significantly associated with hospital mortality (33). …”

Section: Discussionsupporting

confidence: 89%

Sequential Organ Failure Assessment (SOFA) scores differ between genders in a sepsis cohort: Cause or effect?

Jacobson¹,

Liedgren²,

Johansson³

et al. 2012

Upsala Journal of Medical Sciences

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Background. Controversy exists regarding the influence of gender on sepsis events and outcome. Epidemiological data from other countries may not always apply to local circumstances. The aim of this study was to identify gender differences in patient characteristics, treatment, and outcome related to the occurrence of sepsis at admission to the ICU.Methods. A prospective observational cohort study on patients admitted to the ICU over a 3-year period fulfilling sepsis criteria during the first 24 hours. Demographic data, APACHE II score, SOFA score, TISS 76, aetiology, length of stay (LOS), mortality rate, and aspects of treatment were collected and then analysed with respect to gender differences.Results. There were no gender-related differences in mortality or length of stay. Early organ dysfunction assessed as SOFA score at admission was a stronger risk factor for hospital mortality for women than for men. This discrepancy was mainly associated with the coagulation sub-score. CRP levels differed between genders in relation to hospital mortality. Infection from the abdominopelvic region was more common among women, whereas infection from skin or skin structures were more common in men.Conclusion.In this cohort, gender was not associated with increased mortality during a 2-year follow-up period. SOFA score at ICU admission was a stronger risk factor for hospital mortality for women than for men. The discrepancy was mainly related to the coagulation SOFA sub-score. Together with differences in CRP levels this may suggest differences in inflammatory response patterns between genders.

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Section: Discussionsupporting

confidence: 89%

Sequential Organ Failure Assessment (SOFA) scores differ between genders in a sepsis cohort: Cause or effect?

Jacobson¹,

Liedgren²,

Johansson³

et al. 2012

Upsala Journal of Medical Sciences

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“…The results of recent studies support this hypothesis [2,35]. To the contrary, the FEAST trial in African children challenges the need for fluid resuscitation even during the initial phase [17].…”

Section: Discussionsupporting

confidence: 75%

“…In many studies, adequate early fluid resuscitation during the initial few hours after the recognition of shock has been associated with a decrease in mortality [35][36][37][38]. In a multicenter trial involving adult patients with septic shock, mortality was lower when at least 1 L of fluid was administered during the first hour after onset of hypotension followed by vasopressor initiation between 1 and 6 h post-hypotension onset [36].…”

Section: Discussionmentioning

confidence: 99%

Early fluid accumulation in children with shock and ICU mortality: a matched case–control study

et al. 2015

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“…For patients who had shock on ICU admittance, data from the pre-ICU period were not registered, as we previously found low quality of such data in a comparable cohort [8]. …”

Section: Methodsmentioning

confidence: 99%

“…Patients who still had shock on day 3 after inclusion were divided into two groups according to the median fluid volume administered in the first 3 days of shock. This way of comparing higher versus lower fluid volume was previously done for the first 6 and 24 hours in patients with severe sepsis and septic shock, respectively [8,12]. The 3-day time point was chosen because it was used in the SOAP (Sepsis Occurrence in Acutely Ill Patients) cohort [4].…”

Section: Methodsmentioning

confidence: 99%

Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort

Smith

Perner

2012

Crit Care

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IntroductionPatients with septic shock require fluid, but the optimum amount is unknown. Therefore we assessed patient characteristics and outcome associated with fluid volume in unselected patients with septic shock including those with three days of shock.MethodsWe conducted a prospective, multicenter, observational study of all adult patients with septic shock during a 3-month study period at six general ICUs: three in university hospitals and three in regional hospitals. After day 1 and 3 of shock, patients were divided into two groups according to the overall median fluid volumes. Characteristics between these groups were compared using non-parametric and Chi-square statistics.ResultsThe 164 included patients received median 4.0 l (IQR 2.3-6.3) of fluid during the first day of septic shock. Patients receiving higher volumes (> 4.0 l) on day 1 had higher p-lactate (3.4 (2.2-5.5) vs. 2.0 (1.6-3.0) mmol l-1, P < 0.0001) compared to those receiving lower volumes. In contrast simplified acute physiology score (SAPS) II (54 (45-64) vs. 54 (45-67), P = 0.73), sequential organ failure assessment (SOFA) score (11 (9-13) vs. 11 (9-13), P = 0.78) and 90-day mortality (48 vs. 53%, P = 0.27) did not differ between groups. The 95 patients who still had shock on day 3 had received 7.5 l (4.3 - 10.8) of fluid by the end of day 3. Patients receiving higher volumes (> 7.5 l) had higher p-lactate (2.6 (1.7-3.4) vs. 1.9 (1.6-2.4) mmol l-1, P < 0.01) on day 3 and lower 90-day mortality (40 vs. 62%, P = 0.03) than those receiving lower volumes in spite of comparable admission SAPS II (53 (46-67) vs. 55 (49-62), P = 0.47) and SOFA scores on day 3 (10 (8-13) vs. 11 (10-14), P = 0.33).ConclusionsIn this cohort of unselected ICU patients with septic shock, initial fluid volume was not associated with mortality. In patients with shock for three days or more, higher fluid volumes including crystalloids, colloids and blood products were associated with reduced mortality.

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Initial fluid resuscitation of patients with septic shock in the intensive care unit

Abstract: In the ICU, patients with septic shock were resuscitated with a combination of crystalloids, colloids and blood products. Although the more severely shocked patients received higher volumes of crystalloids, colloids and blood products, mortality did not differ between the groups.

Cited by 19 publications

References 18 publications

Sequential Organ Failure Assessment (SOFA) scores differ between genders in a sepsis cohort: Cause or effect?

Sequential Organ Failure Assessment (SOFA) scores differ between genders in a sepsis cohort: Cause or effect?

Early fluid accumulation in children with shock and ICU mortality: a matched case–control study

Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort

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