Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

Kjær, Maj-Brit Nørregaard; Meyhoff, Tine Sylvest; Sivapalan, Praleene; Granholm, Anders; Hjortrup, Peter Buhl; Madsen, Martin Bruun; Møller, Morten Hylander; Egerod, Ingrid; Wetterslev, Jørn; Lange, Theis; Cronhjort, Maria; Laake, Jon Henrik; Jakob, Stephan M.; Nalos, Marek; Ostermann, Marlies; Gould, Doug; Cecconi, Maurizio; Malbrain, Manu L. N. G.; Ahlstedt, Christian; Kiel, Louise Bendix; Bestle, Morten H.; Nebrich, Lars; Hildebrandt, Thomas; Russell, Lene; Vang, Marianne; Rasmussen, Michael Lindhart; Sølling, Christoffer; Brøchner, Anne Craveiro; Krag, Mette; Pfortmueller, Carmen; Kriz, Miroslav; Siegemund, Martin; Albano, Giovanni; Aagaard, Søren Rosborg; Bundgaard, Helle; Crone, Vera; Wichmann, Sine; Johnstad, Bror; Martin, Yvonne Karin; Seidel, Philipp; Mårtensson, Johan; Hollenberg, Jacob; Wistrand, Mats; Donati, Abele; Barbara, Enrico; Karvunidis, Thomas; Hollinger, Alexa; Carsetti, Andrea; Lumlertgul, Nuttha; Joelsson-Alm, Eva; Lambiris, Nikolas; Aslam, Tayyba Naz; Friberg, Fredrik Femtehjell; Vesterlund, Gitte Kingo; Mortensen, Camilla Bekker; Vestergaard, Stine Rom; Caspersen, Sidsel Fjordbak; Jensen, Diana Bertelsen; Borup, Morten; Rasmussen, Bodil Steen; Perner, Anders

doi:10.1007/s00134-023-07114-8

Cited by 10 publications

(1 citation statement)

References 40 publications

(69 reference statements)

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“…The participants were randomly assigned 1:1 to restricted IV fluid or standard IV fluid therapy during their ICU stay for a maximum of 90 days. Additional details on the CLASSIC trial, inclusion and exclusion criteria with full definitions, trial interventions and results after 90 days and 1 year, are available elsewhere [ 10 , 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial

Ahlstedt,

Sivapalan,

Kriz

et al. 2024

Intensive Care Med

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Purpose The aim of this study was to examine the effects of intravenous (IV) fluid restriction on time to resolution of hyperlactatemia in septic shock. Hyperlactatemia in sepsis is associated with worse outcome. Sepsis guidelines suggest targeting lactate clearance to guide fluid therapy despite the complexity of hyperlactatemia and the potential harm of fluid overload. Methods We conducted a post hoc analysis of serial plasma lactate concentrations in a sub-cohort of 777 patients from the international multicenter clinical CLASSIC trial (restriction of intravenous fluids in intensive care unit (ICU) patients with septic shock). Adult ICU patients with septic shock had been randomized to restrictive ( n = 385) or standard ( n = 392) intravenous fluid therapy. The primary outcome, time to resolution of hyperlactatemia, was analyzed with a competing-risks regression model. Death and discharge were competing outcomes, and administrative censoring was imposed 72 h after randomization if hyperlactatemia persisted. The regression analysis was adjusted for the same stratification variables and covariates as in the original CLASSIC trial analysis. Results The hazard ratios (HRs) for the cumulative probability of resolution of hyperlactatemia, in the restrictive vs the standard group, in the unadjusted analysis, with time split, were 0.94 (confidence interval (CI) 0.78–1.14) at day 1 and 1.21 (0.89–1.65) at day 2–3. The adjusted analyses were consistent with the unadjusted results. Conclusion In this post hoc retrospective analysis of a multicenter randomized controlled trial (RCT), a restrictive intravenous fluid strategy did not seem to affect the time to resolution of hyperlactatemia in adult ICU patients with septic shock. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-024-07385-9.

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Section: Methodsmentioning

confidence: 99%

Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial

Ahlstedt,

Sivapalan,

Kriz

et al. 2024

Intensive Care Med

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Fluid Management in Acute Respiratory Failure

Giovanni,

Seitz,

Hough

2024

Critical Care Clinics

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Surviving Sepsis Campaign Research Priorities 2023

De Backer,

Deutschman,

Hellman

et al. 2024

Critical Care Medicine

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OBJECTIVES: To identify research priorities in the management, epidemiology, outcome, and pathophysiology of sepsis and septic shock. DESIGN: Shortly after publication of the most recent Surviving Sepsis Campaign Guidelines, the Surviving Sepsis Research Committee, a multiprofessional group of 16 international experts representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine, convened virtually and iteratively developed the article and recommendations, which represents an update from the 2018 Surviving Sepsis Campaign Research Priorities. METHODS: Each task force member submitted five research questions on any sepsis-related subject. Committee members then independently ranked their top three priorities from the list generated. The highest rated clinical and basic science questions were developed into the current article. RESULTS: A total of 81 questions were submitted. After merging similar questions, there were 34 clinical and ten basic science research questions submitted for voting. The five top clinical priorities were as follows: 1) what is the best strategy for screening and identification of patients with sepsis, and can predictive modeling assist in real-time recognition of sepsis? 2) what causes organ injury and dysfunction in sepsis, how should it be defined, and how can it be detected? 3) how should fluid resuscitation be individualized initially and beyond? 4) what is the best vasopressor approach for treating the different phases of septic shock? and 5) can a personalized/precision medicine approach identify optimal therapies to improve patient outcomes? The five top basic science priorities were as follows: 1) How can we improve animal models so that they more closely resemble sepsis in humans? 2) What outcome variables maximize correlations between human sepsis and animal models and are therefore most appropriate to use in both? 3) How does sepsis affect the brain, and how do sepsis-induced brain alterations contribute to organ dysfunction? How does sepsis affect interactions between neural, endocrine, and immune systems? 4) How does the microbiome affect sepsis pathobiology? 5) How do genetics and epigenetics influence the development of sepsis, the course of sepsis and the response to treatments for sepsis? CONCLUSIONS: Knowledge advances in multiple clinical domains have been incorporated in progressive iterations of the Surviving Sepsis Campaign guidelines, allowing for evidence-based recommendations for short- and long-term management of sepsis. However, the strength of existing evidence is modest with significant knowledge gaps and mortality from sepsis remains high. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

Cited by 10 publications

References 40 publications

Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial

Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial

Fluid Management in Acute Respiratory Failure

Surviving Sepsis Campaign Research Priorities 2023

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