scholarly journals 1403: FLUID ADMINISTRATION IN SEPTIC SHOCK

2021 ◽  
Vol 50 (1) ◽  
pp. 704-704
Author(s):  
Miranda Boraas ◽  
Robert Ross ◽  
Abbie Rosen ◽  
Andrew Franck
Keyword(s):  
Septic Shock ◽  
Fluid Administration

Hypertonic Fluid Administration in Patients With Septic Shock

Shock ◽  
2012 ◽  
Vol 37 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Frank M.P. van Haren ◽  
James Sleigh ◽  
E. Christiaan Boerma ◽  
Mary La Pine ◽  
Mohamed Bahr ◽  
...  
Keyword(s):  
Septic Shock ◽  
Fluid Administration

scholarly journals Fluid Management in Sepsis

2018 ◽  
Vol 34 (5) ◽  
pp. 364-373 ◽  
Author(s):  
Ryan M. Brown ◽  
Matthew W. Semler
Keyword(s):  
Septic Shock ◽  
Patient Outcomes ◽  
Fluid Resuscitation ◽  
Venous Pressure ◽  
Fluid Management ◽  
Optimal Dose ◽  
Fluid Administration ◽  
Source Control ◽  
Bolus Administration ◽  
Risk Of Death

Among critically ill adults, sepsis remains both common and lethal. In addition to antibiotics and source control, fluid resuscitation is a fundamental sepsis therapy. The physiology of fluid resuscitation for sepsis, however, is complex. A landmark trial found early goal-directed sepsis resuscitation reduced mortality, but 3 recent multicenter trials did not confirm this benefit. Multiple trials in resource-limited settings have found increased mortality with early fluid bolus administration in sepsis, and the optimal approach to early sepsis resuscitation across settings remains unknown. After initial resuscitation, excessive fluid administration may contribute to edema and organ dysfunction. Using dynamic variables such as passive leg raise testing can predict a patient’s hemodynamic response to fluid administration better than static variables such as central venous pressure. Whether using measures of “fluid responsiveness” to guide fluid administration improves patient outcomes, however, remains unknown. New evidence suggests improved patient outcomes with the use of balanced crystalloids compared to saline in sepsis. Albumin may be beneficial in septic shock, but other colloids such as starches, dextrans, and gelatins appear to increase the risk of death and acute kidney injury. For the clinician caring for patients with sepsis today, the initial administration of 20 mL/kg of intravenous balanced crystalloid, followed by consideration of the risks and benefits of subsequent fluid administration represents a reasonable approach. Additional research is urgently needed to define the optimal dose, rate, and composition of intravenous fluid during the management of patients with sepsis and septic shock.

Optimizing Fluid Resuscitation and Preventing Fluid Overload in Patients with Septic Shock

2021 ◽  
Vol 42 (05) ◽  
pp. 698-705
Author(s):  
Chandni Ravi ◽  
Daniel W. Johnson
Keyword(s):  
Septic Shock ◽  
Fluid Overload ◽  
Point Of Care ◽  
Venous Pressure ◽  
Fluid Administration ◽  
Point Of Care Ultrasound ◽  
Shock State ◽  
Common Error ◽  
Intravenous Fluid Administration ◽  
Multiple Variables

AbstractIntravenous fluid administration remains an important component in the care of patients with septic shock. A common error in the treatment of septic shock is the use of excessive fluid in an effort to overcome both hypovolemia and vasoplegia. While fluids are necessary to help correct the intravascular depletion, vasopressors should be concomitantly administered to address vasoplegia. Excessive fluid administration is associated with worse outcomes in septic shock, so great care should be taken when deciding how much fluid to give these vulnerable patients. Simple or strict “recipes” which mandate an exact amount of fluid to administer, even when weight based, are not associated with better outcomes and therefore should be avoided. Determining the correct amount of fluid requires the clinician to repeatedly assess and consider multiple variables, including the fluid deficit, organ dysfunction, tolerance of additional fluid, and overall trajectory of the shock state. Dynamic indices, often involving the interaction between the cardiovascular and respiratory systems, appear to be superior to traditional static indices such as central venous pressure for assessing fluid responsiveness. Point-of-care ultrasound offers the bedside clinician a multitude of applications which are useful in determining fluid administration in septic shock. In summary, prevention of fluid overload in septic shock patients is extremely important, and requires the careful attention of the entire critical care team.

Effects of fluid administration on arterial load in septic shock patients

2015 ◽  
Vol 41 (7) ◽  
pp. 1247-1255 ◽  
Author(s):  
Manuel Ignacio Monge García ◽  
Pedro Guijo González ◽  
Manuel Gracia Romero ◽  
Anselmo Gil Cano ◽  
Chris Oscier ◽  
...  
Keyword(s):  
Septic Shock ◽  
Fluid Administration ◽  
Arterial Load

1079: LACK OF FLUID ADMINISTRATION OR LACK OF DOCUMENTATION EVALUATING FLUID RESUSCITATION IN SEPTIC SHOCK

2016 ◽  
Vol 44 (12) ◽  
pp. 345-345
Author(s):  
Christa Schorr ◽  
Erica Hargreaves ◽  
Krystal Hunter ◽  
Christian Nguyen ◽  
Ahmed Sesay ◽  
...  
Keyword(s):  
Septic Shock ◽  
Fluid Resuscitation ◽  
Fluid Administration

scholarly journals P083: IV fluid resuscitation of sepsis patients in London, ON: a retrospective chart review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S106 ◽  
Author(s):  
A. Leung ◽  
A. Aguanno ◽  
K. Van Aarsen
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Fluid Resuscitation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Fluid Administration ◽  
Fluid Volume ◽  
Data Set ◽  
Crystalloid Fluid ◽  
The Impact

Introduction: The Surviving Sepsis Campaign (SSC) suggests that hypovolemic patients, in the setting of hypoperfusion, be administered 30 mL/kg crystalloid fluid within the first 3 hours of presentation to hospital. More recent evidence suggests that fluid resuscitation within 30 min of sepsis identification is associated with reduced mortality, hospital length of stay and ICU days. This study describes Emergency Department (ED) fluid resuscitation of patients with septic shock and/or sepsis-related in-hospital mortality, prior to implementation of a sepsis medical directive. Methods: Retrospective chart review of adult patients (18+ years), presenting to two tertiary care EDs between 01 Nov 2014 and 31 Oct 2015, with >=2 SIRS criteria and/or ED suspicion of infection and/or ED or hospital discharge sepsis diagnosis. Data were abstracted from electronic health records. Patients with septic shock, or who expired in the ED/hospital, were selected for manual chart review of clinical variables including: time, type and volume of ED IV fluid administration. Results: 13,506 patient encounters met inclusion criteria. In-hospital mortality rates were 2% (sepsis), 11.5% (severe sepsis), and 24.1% (septic shock). Of patients hypotensive at triage, fluids were administered to 33/50 (66.00%) septic shock patients, and 22/43 (51.16 %) patients who eventually expired. For all septic shock and expired patients (943), median time to IV fluid initiation was 60.50 minutes [29.75 to 101.25] for septic shock and 77.00 minutes [36.00 to 127.00] for expired patients. Median volume of fluid administered was 1.50L [1.0 to 2.00] for septic shock and 1.00L [1.00 to 2.00] for expired patients. Of septic shock and expired patients, IV fluid administration and body weight data was available for 148 encounters (15.6%). Within this group, 19 (12.8%) received no IV fluid. 90 (60.8%) received 0.1-75% of their recommended IV fluid volume. 25 (16.9%) received 75.1-125%, and 14 (9.4%) received >125.1% of their recommended fluid volume. Conclusion: In this study, severe forms of sepsis were often treated with <30 mL/kg crystalloid fluid. Fluids were administered outside of the recommended 30 min, but within the 3 h, time windows. In-hospital mortality was consistent with published data. Future research will examine a broader data set for IV fluid resuscitation in sepsis, and will measure the impact of a fluid resuscitation in sepsis medical directive.

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