scholarly journals Time to recover from shock is determinant of a positive fluid balance in septic shock

Critical Care ◽  
2013 ◽  
Vol 17 (S2) ◽  
Author(s):  
S Lobo ◽  
AL Cunha
Keyword(s):  
Septic Shock ◽  
Fluid Balance ◽  
Positive Fluid Balance

scholarly journals Association of Positive Fluid Balance and Mortality in Sepsis and Septic Shock in An Australian Cohort

2017 ◽  
Vol 45 (6) ◽  
pp. 737-743 ◽  
Author(s):  
M. G. Pittard ◽  
S. J. Huang ◽  
A. S. McLean ◽  
S. R. Orde
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Confidence Intervals ◽  
Fluid Balance ◽  
Severity Of Illness ◽  
Primary Outcome Measure ◽  
Published Data ◽  
Positive Fluid Balance ◽  
Retrospective Audit ◽  
Sepsis And Septic Shock

In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fluid balance for the first seven days of ICU admission, biochemical data and other clinical indices. The primary outcome measure was survival to hospital discharge. One hundred and eighty-six patients with septic shock were included, with an overall hospital mortality of 23.7%. Seventy-five percent of patients required mechanical ventilation, and 27.4% required haemodialysis. The mean daily fluid balance on the first day of admission was positive 1,424 ml and 1,394 ml for ICU and hospital survivors, respectively. On average, the daily fluid balance for non-survivors was higher than the survivors: ICU non-survivors were 602 (95% confidence intervals 230, 974) ml (P=0.0015) and hospital non-survivors were 530 [95% confidence intervals 197, 863] ml (P=0.0017) higher than the survivors. In line with other recently published data, after adjustment for confounders (severity of illness based on the Acute Physiology and Chronic Health Evaluation score) we found a correlation between positive fluid balance and worsened hospital mortality in critically ill patients with sepsis and septic shock. Further research investigating rational use of fluids in this patient group is needed.

Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock

2015 ◽  
Vol 30 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Fernando Saes Vilaça de Oliveira ◽  
Flavio Geraldo Resende Freitas ◽  
Elaine Maria Ferreira ◽  
Isac de Castro ◽  
Antonio Toneti Bafi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Prognostic Factor ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Positive Fluid Balance ◽  
Sepsis And Septic Shock

Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge

2016 ◽  
Vol 34 (11) ◽  
pp. 2122-2126 ◽  
Author(s):  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Ronen Toledano ◽  
Abraham Borer ◽  
Lior Fucs ◽  
...  
Keyword(s):  
Septic Shock ◽  
Clinical Outcome ◽  
Fluid Balance ◽  
Positive Fluid Balance ◽  
Icu Discharge ◽  
Major Predictor

Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist

2019 ◽  
Vol 54 (4) ◽  
pp. 388-396
Author(s):  
Brittany D. Bissell ◽  
Breanne Mefford
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Patient Care ◽  
Fluid Balance ◽  
Clinical Pharmacist ◽  
Improve Patient Care ◽  
Positive Fluid Balance ◽  
Medline Search ◽  
Icu Stay ◽  
Organ Systems

Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.

scholarly journals The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review

2020 ◽  
Vol 48 (1) ◽  
pp. 11-24
Author(s):  
Timothy G Scully ◽  
Yifan Huang ◽  
Stephen Huang ◽  
Anthony S McLean ◽  
Sam R Orde
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Fluid Balance ◽  
Fluid Therapy ◽  
Transpulmonary Thermodilution ◽  
Venous Pressure ◽  
Positive Fluid Balance ◽  
Central Venous ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy

Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.

scholarly journals The Relationship Between Positive Fluid Balance and Mortality in Septic Shock

2019 ◽  
Author(s):  
Esra Cakir ◽  
Ahmet Bindal ◽  
Nevzat Mehmet Mutlu ◽  
Pakize Özçiftci Yılmaz ◽  
Cihangir Doğu ◽  
...  
Keyword(s):  
Septic Shock ◽  
Fluid Balance ◽  
Positive Fluid Balance ◽  
The Relationship

scholarly journals Relationship Between Fluid Therapy Strategies and Mortality Among Sepsis Patients in ICU with high CVP: A Retrospective Analysis of the eICU Database

2021 ◽  
Author(s):  
Penglei Yang ◽  
Rui Tan ◽  
Ruiqiang Zheng ◽  
Jun Shao ◽  
Jing Yuan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Chronic Heart Failure ◽  
Fluid Balance ◽  
Fluid Therapy ◽  
Sepsis Group ◽  
Positive Fluid Balance ◽  
Negative Fluid Balance ◽  
Positive Balance ◽  
History Of

Abstract Objective: It is still debated whether sepsis patients with high CVP (central venous pressure) benefit from it. We performed a retrospective study of sepsis patients with CVP ≥ 12 mmHg to analyze mortality resulting from the different amounts of fluid administered in the fluid therapy at the first 6, 24, and 48 h of the course.Methods: This study included sepsis patients from the eICU database who met the sepsis-3 diagnostic criteria and showed CVP ≥ 12 mmHg on admission. We analyzed the differences between the survivors and the non-survivors at baseline and the difference in fluid balance at 6, 24, and 48 h. Restricted cubic spline (RCS) and logistic regression model were used to identify the association between fluid balance and mortality.Results: Out of the 1150 sepsis patients that showed a high CVP obtained from the eICU database, 847 were survivors and 303 were non-survivors. Compared to survivors, non-survivors had a larger positive fluid balance at 6, 24, and 48 h. The fluid balance and mortality in sepsis patients with high CVP showed an inverted U-type relationship. At 6 h, lower mortality was found in patients who required less than -5 ml/kg fluid therapy. At 24 h, mortality was the lowest at -40~-20 ml/kg. At 48 h, low mortality was observed in patients with < -40 ml/kg fluid balance. In septic shock patients with high CVP, positive balance decrease mortality. In sepsis patients with high CVP without a history of chronic heart failure, and with a history of heart failure negative fluid balance can decrease mortality.Conclusion: In the sepsis group without shock, achieving negative fluid balance possible may significantly improve the prognosis of patients with high CVP, and patients with no history of chronic heart failure and patients with history of chronic heart failure should limit fluid infusion. In patients with septic shock whose CVP ≥ 12 mmHg, positive fluid balance may decrease mortality.

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