Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study.
Chest. 2014 May 22;
Authors: Lee SJ, Ramar K, Park JG, Gajic O, Li G, Kashyap R
ABSTRACT INTRODUCTION: Surviving Sepsis guidelines recommend early aggressive fluid resuscitation within six hours of sepsis onset time. Though rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking.
HYPOTHESIS: There is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time.
METHODS: This is a retrospective cohort study of consecutive adults with severe sepsis/septic shock who were admitted to a quaternary care medical intensive care unit from January 2007 to December 2009. Data were obtained from a previously validated electronic medical database. Multivariate regression modeling was performed adjusting for age, admission weight, SOFA Score, APACHE, and total fluid administration within the first 6 hours of Sepsis Onset Time.
RESULTS: Out of 651 patients who were screened with severe sepsis/septic shock, 594 patients had detailed fluid data. In an univariate analysis, the median amount of fluid within the first 3 hours for survivors at discharge vs. deaths was 2085 mL (940-4080) vs. 1600 mL (600-3010), p=0.007. In comparison during the latter 3 hours, the median amount was 660 mL (290-1485) vs. 800 mL (360-1680), p=0.09. After adjusting for confounders, the higher proportion of total fluid received within the first 3 hours was associated with decreased hospital mortality [odds ratio 0.34 (95% CI, 0.15 to 0.75), p=0.008].
CONCLUSION: Earlier fluid resuscitation (within the first 3 hours) is associated with greater number of survivors with severe sepsis/septic shock.
PMID: 24853382 [PubMed - as supplied by publisher]