Targeted Fluid Minimization Following initial Resuscitation in Septic Shock: A Pilot Study.
Chest. 2015 Aug 20;
Authors: Chen C, Kollef MH
Abstract
Background: Intravenous fluid (IVF) represents a basic therapeutic intervention for septic shock. Unfortunately optimal administration of IVF to maximize patient outcomes and prevent complications is largely unknown.
Methods: Patients with septic shock admitted to the medical ICUs of Barnes-Jewish Hospital (January - December 2014) requiring vasoactive agents for at least 12 hours following initial fluid resuscitation were randomized to usual care or to targeted fluid minimization (TFM) guided by daily assessments of fluid responsiveness.
Results: 82 patients were enrolled, 41 to usual care and 41 to TFM. For patients randomized to TFM the net median [interquartile range] fluid balance was less at the end of day 3 (1952 mL [48 mL - 5003 mL] versus 3124 mL [767 mL - 10103 mL]; P = 0.20) and at the end of day 5 (2641 mL [-1837 mL - 5075 mL] versus 3616 mL [ -1513 mL - 9746 mL]; P = 0.40). TFM appeared to be safe as indicated by similar clinical outcomes including in-hospital mortality (56.1% versus 48.8%; P = 0.51), ventilator days (8.0 days [3.25 days - 15.25 days] versus 5.0 days [3.0 days - 9.0 days]; P = 0.30), renal replacement therapy (41.5% versus 39.0%; P = 0.82), and vasopressor days (4.0 days [2.0 days - 8.0 days] versus 4.0 days [2.0 days - 6.0 days]; P = 0.84).
Conclusions: This pilot study suggests that TFM in patients with septic shock can be performed using protocol-guided assessments of fluid responsiveness. Larger trials of TFM in septic shock are needed.
ClinicalTrials.gov Identifier: NCT02473718.
PMID: 26291900 [PubMed - as supplied by publisher]