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Impact of initial fluid resuscitation volume on clinical outcomes in patientswith heart failure and septic shock

Journal of Intensive Medicine 2023年第3期3卷 254-260页

作者： Adam L.Wiss Bruce A.Doepker Brittany Hoyte Logan M.Olson Kathryn A.Disney Eric M.McLaughlin vincent esguerra Jessica L.Elefritz Department of Pharmacy Ascension Saint Thomas Hospital WestNashvilleTN 37205USA Department of Pharmacy The Ohio State University Wexner Medical CenterColumbusOH 43210USA Department of Pharmacy Corewell HealthGrand RapidsMI 49503USA Department of Pharmacy Nebraska MedicineOmahaNE 68105USA Department of Pharmacy Huntsman Cancer Institute at the University of UtahSalt Lake CityUT 84112USA Center for Biostatistics The Ohio State UniversityColumbusOH 43210USA Division of Pulmonary AllergyCritical Careand Sleep Medicine.The Ohio State University Wexner Medical CenterColumbusOH 43210USA

Background:Fluid resuscitation is a key treatment for sepsis,but limited data exists in patients with existing heartfailure(HF)and septic *** objective of this study was to determine the impact of initial fluid resuscitationvolume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction(LVEF)withseptic ***:This multicenter,retrospective,cohort study included patients with known HF(LVEF≤50%)presentingwith septic *** were divided into two groups based on the volume of fluid resuscitation in the first 6 h;<30 mL/kg or≥30 mL/*** primary outcome was a composite of in-hospital mortality or renal replacementtherapy(RRT)within 7 *** outcomes included acute kidney injury(AKI),initiation of mechanicalventilation,and length of stay(LOS).All related data were collected and compared between the two groups.A generalized logistic mixed model was used to assess the association between fluid groups and the primaryoutcome while adjusting for baseline LVEF,Acute Physiology and Chronic Health Evaluation(APACHE)II score,inappropriate empiric antibiotics,and receipt of ***:One hundred and fifty-four patients were included(93 patients in<30 mL/kg group and 61 patientsin≥30 mL/kg group).The median weight-based volume in the first 6 h was 17.7(12.2–23.0)mL/kg in the<30 mL/kg group vs.40.5(34.2–53.1)mL/kg in the≥30 mL/kg group(P<0.01).No statistical difference was detected in the composite of in-hospital mortality or RRT between the<30 mL/kg group compared to the≥30 mL/kggroup(55.9%vs.45.9%,P=0.25),***<30 mL/kg group had a higher incidence of AKI,mechanicalventilation,and longer hospital ***:In patients with known reduced or mildly reduced LVEF presenting with septic shock,no differencewas detected for in-hospital mortality or RRT in patients who received≥30 mL/kg of resuscitation fluid comparedto less fluid,although this study was underpowered to detect a ***

关键词： Sepsis Septic shock Heart failure Fluid resuscitation

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