Effect of initial infusion rates of fluid resuscitation on outcomes in patients with septic shock: a historical cohort study

Abstract

Background: Fluid resuscitation has become the cornerstone of early septic shock management, but the optimal fluid rate is still not well studied. The goal of this investigation is to examine the relationship between fluid resuscitation rate and septic shock resolution. Method: We retrospectively studied adult (≥ 18 years) patients with septic shock, defined based on sepsis III definition, from January 1, 2006, through May 31, 2018, in the medical intensive care unit (MICU) of Mayo Clinic Rochester. The fluid resuscitation time was defined as the time required to infuse the initial fluid bolus of 30 ml/kg, based on the recommendations of the 2016 surviving sepsis campaign. The cohort was divided into four groups based on the average fluid rate (group 1 ≥ 0.5, group 2 0.25-0.49, group 3 0.17-0.24, and group 4 < 0.17 ml/kg/min). The primary outcome was the time to shock reversal. Multivariable regression analyses were conducted to account for potential confounders. Result: A total of 1052 patients met eligibility criteria and were included in the analysis. The time-to-shock reversal was significantly different among the groups (P < .001). Patients in group 1 who received fluid resuscitation at a faster rate had a shorter time to shock reversal (HR = 0.78; 95% CI 0.66-0.91; P = .01) when compared with group 4 with a median (IQR) time-to-shock reversal of 1.7 (1.5, 2.0) vs. 2.8 (2.6, 3.3) days, respectively. Using 0.25 ml/kg/min as cutoff, the higher fluid infusion rate was associated with a shorter time to shock reversal (HR = 1.22; 95% CI 1.06-1.41; P = .004) and with decreased odds of 28-day mortality (HR = 0.71; 95% CI 0.60-0.85; P < .001). Conclusion: In septic shock patients, initial fluid resuscitation rate of 0.25-0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV fluid resuscitation within the first 2 h), may be associated with early shock reversal and lower 28-day mortality compared with slower rates of infusion.In this study, we assess the impact of the initial fluid replacement rate on the outcome of patients with septic shock managed based on Surviving Sepsis Campaign (SSC) guidelines. We found among septic shock patients the minimum initial fluid resuscitation rate of 0.25-0.50 ml/kg/min (i.e., completion of the initial 30 ml/kg IV fluid resuscitation within the first 2 h) is associated with a shorter time to shock reversal and improved patient outcome.

Effect of Initial Infusion Doses of Fluid Resuscitation on Prognosis in Patients with Septic Shock: A Prospective Multicentre Observational Study

“…The study further showed that an initial uid resuscitation rate of 20-30 ml/kg within the rst 1 h or completion of the initial 30 ml/kg uid resuscitation between the rst 1-2 h may be associated with faster organ function recovery and lower 28-day mortality in patients with septic shock. This nding is consistent with a recent retrospective study [10], which found that an initial uid resuscitation rate of 0.25-0.50 ml/kg/min may be associated with early septic shock reversal and lower 28-day mortality compared with slower rates of infusion. Thus, using an appropriate initial uid resuscitation rate may improve the prognosis of patients with septic shock.…”

“…Moreover, septic shock patients who completed 30 ml/kg initial uid resuscitation between the rst 1-2 h had a lower 28-day mortality rate and faster organ function recovery. This nding is consistent with a recent retrospective study, which found that an initial uid resuscitation rate of 0.25-0.50 ml/kg/min may be associated with early shock reversal and lower 28-day mortality compared with slower rates of infusion [16]. In addition, this study showed that insu cient initial uid resuscitation (below 20 ml/kg within the rst 1 h) may increase 28-day mortality in these patients.…”

“…Another study [10] on critical care published this year showed that an initial uid resuscitation rate of 0.25-0.50 ml/kg/min may be associated with early shock reversal and lower 28-day mortality in septic shock patients. Nonetheless, a few trials have demonstrated increased mortality with uid resuscitation [11][12].…”

Inpatient Kidney Function Recovery among Septic Shock Patients Who Initiated Kidney Replacement Therapy in the Hospital

“…From January 1, 2006, to May 31, 2018, 217,696 patients were admitted to ICUs and 19,773 patients were admitted to MICU at the Mayo Clinic, Rochester. Among these MICU patients, 2,241 patients had septic shock, but only 1,052 individuals had initial resuscitation at MICU (this cohort is previously reported elsewhere [15]), and of those, 229 (22%) developed AKI and initiated kidney replacement therapy at the MICU. Among 158 ICU survivors, 73 (46%) patients were weaned from RRT in ICU and 85 (54%) were transitioned to intermittent RRT.…”

The effects of a limited infusion rate of fluid in the early resuscitation of sepsis on glycocalyx shedding measured by plasma syndecan-1: a randomized controlled trial

“…Typically, fluid in the resuscitation phase was given rapidly, with the rate at least 500 ml over 15 min or 2000 ml/h [ 2 ]. A recent study revealed that completion of the initial 30 ml/kg fluid resuscitation within 2 h was associated with faster shock resolution and decreased sepsis mortality when compared with a slower infusion rate [ 3 ].…”