Early Liberal Fluid Therapy for Sepsis Patients Is Not Harmful: Hydrophobia Is Unwarranted but Drink Responsibly

Jaehne, Anja Kathrin; Rivers, Emanuel P.

doi:10.1097/ccm.0000000000002145

Cited by 18 publications

(11 citation statements)

References 64 publications

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“…3,4 Sepsis is characterized by the host's reaction to a pathogen, characterized by inflammation, microcirculatory disruption, endothelial activation and injury, direct end-organ damage from circulating cytokines, and dysregulation of the coagulation system. 3,5,6 Inflammatory tumor necrosis factor, tumor necrosis factor receptor 1 (TNF-R1), interleukin-6 (IL-6), interleukin-1 β (IL-1β), and chemokines cause a systemic inflammatory response, whereas von Willebrand factor antigen-2 (vWFA2), intercellular adhesion molecule-1 (ICAM-1), and angiopoietin-2 (Ang-2) are released because of endothelial injury and activation. [7][8][9][10][11][12][13] Increased anti-inflammatory mediators such as interleukin-10 (IL-10), transforming growth factor-1β, and interleukin-1ra characterize the compensatory anti-inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Distinct Biomarker Profiles Distinguish Malawian Children with Malarial and Non-malarial Sepsis

Kortz

Nyirenda

Tembo

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Presently, it is difficult to accurately diagnose sepsis, a common cause of childhood death in sub-Saharan Africa, in malaria-endemic areas, given the clinical and pathophysiological overlap between malarial and non-malarial sepsis. Host biomarkers can distinguish sepsis from uncomplicated fever, but are often abnormal in malaria in the absence of sepsis. To identify biomarkers that predict sepsis in a malaria-endemic setting, we retrospectively analyzed data and sera from a case-control study of febrile Malawian children (aged 6-60 months) with and without malaria who presented to a community health center in Blantyre (January-August 2016). We characterized biomarkers for 29 children with uncomplicated malaria without sepsis, 25 without malaria or sepsis, 17 with malaria and sepsis, and 16 without malaria but with sepsis. Sepsis was defined using systemic inflammatory response criteria; biomarkers (interleukin-6 [IL-6], tumor necrosis factor receptor-1, interleukin-1 β [IL-1β], interleukin-10 [IL-10], von Willebrand factor antigen-2, intercellular adhesion molecule-1, and angiopoietin-2 [Ang-2]) were measured with multiplex magnetic bead assays. IL-6, IL-1β, and IL-10 were elevated, and Ang-2 was decreased in children with malaria compared with non-malarial fever. Children with non-malarial sepsis had greatly increased IL-1β compared with the other subgroups. IL-1β best predicted sepsis, with an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.57-0.85); a combined biomarker-clinical characteristics model improved prediction (AUROC of 0.77, 95% CI: 0.67-0.85). We identified a distinct biomarker profile for non-malarial sepsis and developed a sepsis prediction model. Additional clinical and biological data are necessary to further explore sepsis pathophysiology in malaria-endemic regions.

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Section: Introductionmentioning

confidence: 99%

Distinct Biomarker Profiles Distinguish Malawian Children with Malarial and Non-malarial Sepsis

Kortz

Nyirenda

Tembo

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…Prompt and adequate fluid administration to restore the microcirculation is a fundamental management strategy for patients with sepsis [ 2 , 3 ], and increasing evidence has suggested an association between worse outcomes and positive cumulative fluid balance in patients with sepsis and acute respiratory distress syndrome (ARDS) [ 4 – 6 ]. Optimal fluid administration is a complex process in the management of sepsis, and inadequate early fluid rescue may lead to endothelial damage and additional difficulties in subsequent fluid administration strategies [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza: A multicenter retrospective cohort study in Taiwan

et al. 2018

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BackgroundFluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU).MethodsThis multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis.ResultsA total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007–1.174).ConclusionsA negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.

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“…The level of evidence for broad spectrum antibiotics is moderate but remains low for the fluid bolus [ 16 ]. It is the fluid bolus that generates the most discussion [ 17 18 ], and it is therefore not surprising that this bundle element had the lowest adoption among non-mature sites. Compliance with intravenous fluids has been the topic of multiple learning and educational sessions as part of this project (described elsewhere in this journal).…”

Section: Discussionmentioning

confidence: 99%

Dissemination and Implementation of Evidence Based Best Practice Across the High Value Healthcare Collaborative (HVHC) Using Sepsis as a Prototype – Rapidly Learning from Others

Taenzer

Kinslow

Gorman

et al. 2017

eGEMs

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The dissemination of evidence-based best practice through the entire health care system remains an elusive goal, despite public pressure and regulatory guidance. Many patients do not receive the same quality of care at different hospitals across the same health care system. We describe the role of a data driven learning collaborative, the High Value Healthcare Collaborative (HVHC), in the dissemination of best practice using adherence to the 3-hour-bundle for sepsis care. Compliance with and adoption of sepsis bundle care elements comparing sites with mature vs non-mature care delivery processes were measured during the improvement effort for a cohort of 20,758 patients. Non-mature sites increased their bundle compliance from 71.0 to 86.7 percent (p < 0.005). This compliance increase was primarily based on increased compliance with the fluid element of the bundle that improved for non-mature locations from 76.4 to 94.0 percent (p < 0.005).

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Early Liberal Fluid Therapy for Sepsis Patients Is Not Harmful: Hydrophobia Is Unwarranted but Drink Responsibly

Cited by 18 publications

References 64 publications

Distinct Biomarker Profiles Distinguish Malawian Children with Malarial and Non-malarial Sepsis

Distinct Biomarker Profiles Distinguish Malawian Children with Malarial and Non-malarial Sepsis

Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza: A multicenter retrospective cohort study in Taiwan

Dissemination and Implementation of Evidence Based Best Practice Across the High Value Healthcare Collaborative (HVHC) Using Sepsis as a Prototype – Rapidly Learning from Others

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