Fluid balance and cardiac function in septic shock as predictors of hospital mortality.

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Fluid balance and cardiac function in septic shock as predictors of hospital mortality.

Crit Care. 2013 Oct 20;17(5):R246

Authors: Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH

Abstract
INTRODUCTION: Septic shock is a major cause of morbidity and mortality throughout the world. Unfortunately, the optimal fluid management of septic shock is unknown and currently is empirical.
METHODS: A retrospective analysis was performed at Barnes-Jewish Hospital (St. Louis, Missouri). Consecutive patients (n = 325) hospitalized with septic shock who had echocardiographic examinations performed within 24 hours of shock onset were enrolled.
RESULTS: 163 (50.2%) patients with septic shock died during hospitalization. Nonsurvivors had a significantly larger positive net fluid balance within the 24 hour window of septic shock onset [median (IQR): 4374 ml (1637 ml, 7260 ml) vs. 2959 ml (1639.5 ml, 4769.5 ml), p = 0.004]. The greatest quartile of positive net fluid balance at 24 hours and 8 days post-shock onset respectively were found to predict hospital mortality, and the greatest quartile of positive net fluid balance at 8 days post-shock onset was an independent predictor of hospital mortality (AOR, 1.66; 95% CI, 1.39-1.98; p = 0.004). Survivors were significantly more likely to have mild left ventricular dysfunction as evaluated by bedside echocardiography and nonsurvivors had slightly elevated left ventricular ejection fraction, which was also found to be an independent predictor of outcome.
CONCLUSIONS: Our data confirms the importance of fluid balance and cardiac function as outcome predictors in patients with septic shock. A clinical trial to determine the optimal administration of intravenous fluids to patients with septic shock is needed.

PMID: 24138869 [PubMed - as supplied by publisher]

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