Abstract
OBJECTIVESThe 2018 Surviving Sepsis Campaign (SSC) recommends rapid administration of 30 ml/kg crystalloid for hypotension or lactate ≥4 mmol/L in patients with septic shock; however, there is no credible evidence to support this recommendation. The purpose of this study was to examine the relationship between initial fluid resuscitation doses and prognosis in patients with septic shock.METHODSThis was a multicentre prospective observational study of adult patients with septic shock admitted to four intensive care units (ICUs) in a total of three Jiangsu province teaching hospitals over a 1-year span from May 8, 2018, to June 31, 2020. All enrolled patients with septic shock were categorized as below 20 ml/kg fluid, 20-30 ml/kg fluid and above 30 ml/kg fluid groups according to initial infusion doses of fluid resuscitation. Various demographic and other variables were collected from medical records. Logistic regression analysis and curve fitting were used to determine the relationship between initial fluid resuscitation and patient outcome.MEASUREMENTS AND MAIN RESULTSA total of 153 patients who presented to the ICU were diagnosed with septic shock. The 28-day mortality was highest in the fluid above 30 ml/kg group (47.8%) and lowest in the fluid 20-30 ml/kg group (26.5%, P<0.05). Patients who completed 30 ml/kg initial fluid resuscitation between the first 1-2 h had the lowest 28-day mortality rate (25.9%, P<0.05). Logistic regression showed that an initial liquid dose of 20-30 ml/kg was an independent protective factor, with a significant Odds Ratio(OR) or decreased mortality (OR, 0.393; 95% CI, 0.178-0.866; P<0.05). According to the curve fit, the sequential organ failure assessment change value (∆SOFA) was highest for initial fluid resuscitation with 25.7 ml/kg within 1 h, reaching 5.807; the ∆SOFA score reached the maximum value (5.56) when the initial fluid resuscitation of 30 ml/kg was completed in 2.18 hours.CONCLUSIONIn septic shock patients, an initial fluid resuscitation rate of 20-30 ml/kg within the first 1 h or completion of the initial 30 ml/kg fluid resuscitation between the first 1-2 h may be associated with faster organ function recovery and lower 28-day mortality.Trial registration: Chinese Clinical Trial Registry, ChiCTR-OOC-17013223. Registered 2 November 2017, http://www.chictr.org.cn/showproj.aspx?proj=22674
Prognosis of patients excluded by the definition of septic shock based on their lactate levels after initial fluid resuscitation: a prospective multi-center observational study