Fluid volume, fluid balance and patient outcome in severe sepsis and septic shock: A systematic review

Tigabu, Bereket Molla; Davari, Majid; Kebriaeezadeh, Abbas; Mojtahedzadeh, Mojtaba

doi:10.1016/j.jcrc.2018.08.018

Cited by 95 publications

(64 citation statements)

References 35 publications

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“…Even though insufficient fluid resuscitation can decrease tissue perfusion and affect mortality, a growing body of evidence suggests that, in septic shock, excessive fluid administration might be harmful [4][5][6][7]. Furthermore, only half of patients respond to fluid challenges with increases in cardiac output [45].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the fact that the compliance with the SSC has been associated with improved outcomes [2,3], aggressive fluid administration and its consequence of volume overload can increase the mortality of septic patients [4][5][6][7]. Given that both insufficient and excessive administration of solutions might be harmful, fluid management in sepsis should be carefully optimized.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin

Loudet

Edul

et al. 2020

Ann. Intensive Care

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Background: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality.Methods: Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis.Results: Initially, 584 of 787 patients (74%) had mean arterial pressure (MAP) < 65 mm Hg and/or signs of hypoperfusion and received 30 mL/kg of fluids, mostly normal saline (53%) and Ringer lactate (35%). Vasopressors and/ or inotropes were administered in 514 (65%) patients, mainly norepinephrine (100%) and dobutamine (9%); in 22%, vasopressors were administered before ending the fluid load. After this, 413 patients (53%) presented persisting or recurrent hypotension and/or hypoperfusion, which prompted administration of additional fluid, based on: lactate levels (66%), urine output (62%), heart rate (54%), central venous O 2 saturation (39%), central venous-arterial PCO 2 difference (38%), MAP (31%), dynamic tests of fluid responsiveness (30%), capillary-refill time (28%), mottling (26%), central venous pressure (24%), cardiac index (13%) and/or pulmonary wedge pressure (3%). Independent predictors of mortality were SOFA and Charlson scores, lactate, requirement of mechanical ventilation, and utilization of dynamic tests of fluid responsiveness. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin

Loudet

Edul

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

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“…Early intravenous (IV) fluid resuscitation is a necessary tool to improve hemodynamic stability and organ perfusion and possibly decrease mortality in critically ill patients admitted to the intensive care unit (ICU) [1,2]. However, the benefit of continued fluid administration after the first 24-48 h is unclear.…”

Section: Introductionmentioning

confidence: 99%

Impact of protocolized diuresis for de-resuscitation in the intensive care unit

et al. 2020

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Objective: Administration of diuretics has been shown to assist fluid management and improve clinical outcomes in the critically ill post-shock resolution. Current guidelines have not yet included standardization or guidance for diuretic-based de-resuscitation in critically ill patients. This study aimed to evaluate the impact of a multi-disciplinary protocol for diuresis-guided de-resuscitation in the critically ill. Methods: This was a pre-post single-center pilot study within the medical intensive care unit (ICU) of a large academic medical center. Adult patients admitted to the Medical ICU receiving mechanical ventilation with either (1) clinical signs of volume overload via chest radiography or physical exam or (2) any cumulative fluid balance ≥ 0 mL since hospital admission were eligible for inclusion. Patients received diuresis per clinician discretion for a 2-year period (historical control) followed by a diuresis protocol for 1 year (intervention). Patients within the intervention group were matched in a 1:3 ratio with those from the historical cohort who met the study inclusion and exclusion criteria. Results: A total of 364 patients were included, 91 in the protocol group and 273 receiving standard care. Protocolized diuresis was associated with a significant decrease in 72-h post-shock cumulative fluid balance [median, IQR − 2257 (− 5676-920) mL vs 265 (− 2283-3025) mL; p < 0.0001]. In-hospital mortality in the intervention group was lower compared to the historical group (5.5% vs 16.1%; p = 0.008) and higher ICU-free days (p = 0.03). However, no statistically significant difference was found in ventilator-free days, and increased rates of hypernatremia and hypokalemia were demonstrated. Conclusions: This study showed that a protocol for diuresis for de-resuscitation can significantly improve 72-h post-shock fluid balance with potential benefit on clinical outcomes.

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“…However, only 40-50% of patients with unstable haemodynamics can benefit from fluid therapy (3). On the other hand, fluid overload is associated with increased mortality in critically ill patients (4). Therefore, much attention is being paid to the assessment of fluid responsiveness, i.e., the response of cardiac output (CO) or stroke volume (SV) to fluid challenge (FC).…”

Section: Introductionmentioning

confidence: 99%

N-terminal pro-B-type natriuretic peptide for predicting fluid challenge in patients with septic shock

Huang

Xu²,

Liu

et al. 2019

Ann. Transl. Med

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Background: The aim of this study is to examine whether plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration could predict fluid responsiveness in septic shock patients following fluid challenge (FC). Methods: We reviewed prospectively collected data from 79 septic shock patients who received invasive cardiac output (CO) monitoring following a 500 mL FC. Haemodynamics were recorded, and blood sampling for NT-proBNP values was performed. Patients were divided into responders and non-responders according to fluid responsiveness, which was defined as cardiac index (CI) increase ≥10% induced by FC. The NT-proBNP and the CI changes were analysed using Pearson correlation. The area under the curve (AUC) for NT-proBNP was used to test its ability to distinguish responders and non-responders. Subgroup analyses were also explored. Results: Among 79 patients, there were 55 responders. High NT-proBNP values were common in the study cohort. Baseline NT-proBNP values were comparable between responders and non-responders. In general, NT-proBNP values were not significantly correlated with CI changes after FC (r=−0.104, P=0.361). Similarly, the NT-proBNP baseline values could not identify responders to FC with an AUC of 0.508 (95% confidence interval, 0.369-0.647). This result was further confirmed in the subgroup analyses. Conclusions: Baseline NT-proBNP concentration value may not serve as an indicator of fluid responsiveness in patients with septic shock and should not be an indicator to withhold fluid loading.

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Fluid volume, fluid balance and patient outcome in severe sepsis and septic shock: A systematic review

Cited by 95 publications

References 35 publications

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Impact of protocolized diuresis for de-resuscitation in the intensive care unit

N-terminal pro-B-type natriuretic peptide for predicting fluid challenge in patients with septic shock

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