Although resuscitation with intravenous fluids (IVF) is the cornerstone of sepsis management, consensus regarding their association with improvement in clinical outcomes is lacking.
Is there a difference in the incidence of respiratory failure in patients with sepsis who received guideline-recommended initial intravenous fluid bolus of 30 cc/kg or more conservative resuscitation of fewer than 30 cc/kg?
Retrospective analysis of prospectively collected clinical data conducted at an academic medical center in Omaha, Nebraska. We abstracted data from 214 patients with sepsis admitted to a single academic medical center between June 2017 and June 2018. Patients were stratified by receipt of guideline-recommended fluid bolus. The primary outcome was respiratory failure defined as an increase in oxygen flow rate or more intense oxygenation/ventilation support; oxygen requirement and volume were measured at admission, 6 hours, 12 hours, 24 hours, and at discharge. Subgroup analyses were conducted in high-risk patients with Congestive heart failure (CHF)as well as those with Chronic Kidney Disease (CKD).
A total of 62 (29.0%) patients received appropriate bolus. The overall rate of respiratory failure was not statistically different between patients who received appropriate bolus or not (40.3% vs. 36.8%, p = 0.634). Likewise, no differences were observed in time-to-respiratory failure (p = 0.645) or risk of respiratory failure (adjusted hazard ratio 1.1 [95% CI 0.7-1.7], p = 0.774). Results were similar within the high-risk CHF and CKD subgroups.
In this single-center retrospective study we found by broadly defining respiratory failure as an increase in oxygen requirements, a conservative initial IVF resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure.
Copyright © 2020. Published by Elsevier Inc.