Original ContributionFluid balance in sepsis and septic shock as a determining factor of mortality
Introduction
In severe sepsis and septic shock, the main elements of treatment are intravenous fluids, appropriate antibiotics, source control, vasopressors, and ventilatory support [1]. For more than 10 years, the administration of intravenous fluids has been known as a key in the initial stages of sepsis resuscitation, as proven by a classic article on goal-based treatments [2]. Anyway, it is now recognized that the administration of excess fluid in sepsis may lead to worsened respiratory function, increased intraabdominal pressure, worsened coagulopathy, and increased probability of cerebral edema [3]. Some authors observed difficulty in fluid balance management in critically ill patients, and positive fluid balance is associated with increased mortality rates in patients with acute lung injury and septic shock [4], [5]. For all these reasons, the present observational study was designed to assess whether fluid balance has a determinant impact on mortality in a well-defined cohort of patients with severe sepsis or septic shock.
Section snippets
Population and data collection
Our study includes the patients admitted consecutively in the intensive care unit (ICU) of a teaching hospital for 4 months (from October 2012 to January 2013) that were diagnosed with severe sepsis or septic shock. It is a prospective and observational study on an inception cohort. Patients with septic shock were identified by a specific team of intensivists. Demographic, laboratory, and clinical data were registered: age, sex, time of septic shock onset, focus of infection, presence of
Results
A total of 42 patients were included in the analysis. Epidemiologic results were as follows: predominance of men (64.3%); mean age was 61.8 ± 15.9 years; cases of septic shock were predominant (69%). Positive blood cultures were obtained in 17 patients (40.5% of the cases). The most frequent initial infectious focus was abdominal (48%), followed by respiratory (17%). Infections were community acquired in almost 70% of the cases. Severity scores upon ICU admission were 44.6 ± 16.1 and 7.1 ± 3.4
Discussion
Our observational study shows that the accumulated positive fluid balance at 48, 72, and 96 hours is associated with higher mortality in ICU-admitted patients with sepsis or septic shock.
These results are consistent with those by Boyd et al [5], who showed that higher positive fluid balance in resuscitation over the first 4 days was associated with increased risk of mortality in septic shock patients. Other factors such as creatinine, lactate, SatvO2, and troponin showed no statistical
References (15)
- et al.
The importance of fluid management in acute lung injury secondary to septic shock
Chest
(2009) - et al.
Towards a less invasive approach to the early goal-directed treatment of septic shock in the ED
Am J Emerg Med
(2014) - et al.
Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012
Crit Care Med
(2013) - et al.
Early goal-directed therapy in the treatment of severe sepsis and septic shock
N Engl J Med
(2001) - et al.
Comparison of two fluid-management strategies in acute lung injury
N Engl J Med
(2006) - et al.
Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality
Crit Care Med
(2011) - et al.
A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study
JAMA
(1993)