Sepsis, the Administration of IV Fluids, and Respiratory Failure

Jagan, Nikhil; Morrow, Lee E.; Walters, Ryan W.; Plambeck, Robert; Patel, Tej M.; Kalian, Karson F.; Macaraeg, Jeffrey; Dyer, Emily D.; Bergh, A. A. van den; Fried, Aaron J.; Moore, Douglas R.; Malesker, Mark A.

doi:10.1016/j.chest.2020.10.078

Cited by 7 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of ≥30 mL/Kg fluid bolus in patients presenting with SeS or SS was found to be generally low in the previous studies, regardless of the presence of comorbidities [ 10 , 15 , 26 ]. But the time to initiate fluid resuscitation was longer in patients with heart failure, and in patients with kidney failure, which increased mortality [ 26 ].…”

Section: Discussionmentioning

confidence: 88%

“…Our study found that the need for mechanical ventilation increased the chances of in-hospital mortality. There are a few retrospective studies where the authors concluded that the use of ≥30 mL/Kg fluid bolus in CHF patients was not associated with increased mortality or respiratory failure [ 14 , 15 ]. Additionally, some studies supported similar findings not only for CHF patients but also for other conditions that are generally considered high risk for fluid overload such as ESRD on hemodialysis (HD) and cirrhosis [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Jagan et al . observed that patients who received ≥30 mL/Kg fluid bolus had a higher incidence of vasopressors use [ 15 ]. Zhou D et al .…”

Section: Discussionmentioning

confidence: 99%

“…But the time to initiate fluid resuscitation was longer in patients with heart failure, and in patients with kidney failure, which increased mortality [ 26 ]. Also, the CHF patients were less likely to get a total of 30 mL/Kg fluid bolus [ 15 , 18 , 26 , 27 ]. The further categorization of CHF based on ejection fraction per AHA guidelines was not done in previous studies.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

et al. 2021

View full text Add to dashboard Cite

Background The use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data. Methods The retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation. Results The use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82–0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93–1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90–0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus. Conclusion The use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.

show abstract

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

“…Jagan et al . observed that patients who received ≥30 mL/Kg fluid bolus had a higher incidence of vasopressors use [ 15 ]. Zhou D et al .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…15,16,24 Previous literature in fluid-sensitive populations has not found a difference in escalation of respiratory support in those receiving recommended resuscitation volumes. 11,12,25,26 However, these findings may not be directly applicable to those with PH given the differences in the underlying disease states. Additionally, the application of respiratory support in the PH group may have been related to the aggressive management of hypoxia and acidosis, secondary to hypercapnia, to prevent elevations in PVR and subsequent RVF.…”

Section: Discussionmentioning

confidence: 98%

Fluid resuscitation and relation to respiratory support escalation in patients with and without pulmonary hypertension with sepsis

Fronrath,

Hencken,

Martz

et al. 2023

Pharmacotherapy

View full text Add to dashboard Cite

PurposeTo compare guideline‐based fluid resuscitation and need for respiratory support escalation in septic patients with pulmonary hypertension (PH) to those without PH.MethodsThis was a single center, retrospective cohort study (November 2013‐December 2019) of patients with or without PH hospitalized and diagnosed with sepsis. Patients with sepsis were included into two groups based on a previous PH diagnosis or no PH diagnosis. The primary outcome was incidence of respiratory support escalation within 72 hours from sepsis time zero. Respiratory support escalation included high‐flow nasal cannula, bilevel positive airway pressure, or intubation.ResultsOne‐hundred and four patients were included with 52 patients in each study group. Patients with PH were more likely to require escalation of respiratory support compared to non‐PH patients (32.7% vs 11.5%; p=0.009). Fewer patients with PH received 30 mL/kg of crystalloid within 6 hours of time zero compared with non‐PH patients (3.8% vs 42.3%; p<0.001). Vasopressor initiation was more common in patients with PH compared with the non‐PH group (40.4% vs 19.2%; p=0.018). PH diagnosis was the only independent predictor of respiratory support escalation.ConclusionsDuring initial sepsis management when compared to patients without PH, patients with PH had increased instances of respiratory support escalation within 72 hours of sepsis time zero despite lower fluid resuscitation volumes.

show abstract

Do septic patients with reduced left ventricular ejection fraction require a low-volume resuscitative strategy?

Ehrman

Ottenhoff

Favot

et al. 2022

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Sepsis, the Administration of IV Fluids, and Respiratory Failure

Cited by 7 publications

References 22 publications

Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

Fluid resuscitation and relation to respiratory support escalation in patients with and without pulmonary hypertension with sepsis

Do septic patients with reduced left ventricular ejection fraction require a low-volume resuscitative strategy?

Contact Info

Product

Resources

About