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Volume Overload: Prevalence, Risk Factors and Functional Outcome in Survivors of Septic Shock.
Ann Am Thorac Soc. 2015 Sep 22;
Authors: Mitchell KH, Carlbom D, Caldwell E, Leary PJ, Himmelfarb J, Hough CL
Abstract
RATIONALE: Survivors of septic shock have impaired functional status. Volume overload is associated with poor outcomes in patients with septic shock, but the impact of volume overload on functional outcome and discharge destination of survivors is unknown.
OBJECTIVES: This study describes patterns of fluid management both during and after septic shock, and examines factors associated with volume overload on intensive care unit (ICU) discharge. We then examine associations between volume overload on ICU discharge and mobility limitation and discharge to a healthcare facility in septic shock survivors, with the hypothesis that volume overload is associated with increased odds of these outcomes.
METHODS: We retrospectively reviewed the medical records of 247 patients admitted with septic shock to an academic county hospital from June 2009 to April 2012, who survived to ICU discharge. We defined volume overload as a fluid balance expected to increase the subject's admission weight by 10%. Statistical methods included unadjusted analyses and multivariable logistic regression.
MEASUREMENTS AND MAIN RESULTS: Eighty-six percent of patients had a positive fluid balance and 35% had volume overload on ICU discharge. Factors associated with volume overload in unadjusted analyses included more severe illness, cirrhosis, blood transfusion during shock, and higher volumes of fluid administration both during and after shock. Blood transfusion during shock was independently associated with increased odds of volume overload (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.33-5.27, p=0.01) after adjusting for pre-existing conditions and severity of illness. Only 42% of patients received at least one dose of diuretic during their hospitalization. Volume overload on ICU discharge was independently associated with inability to ambulate on hospital discharge (OR 2.29, 95% CI 1.24-4.25, p=0.01) and, in patients admitted from home, discharge to a healthcare facility (OR 2.34, 95% CI 1.1-4.98, p=0.03).
CONCLUSIONS: Volume overload is independently associated with impaired mobility and discharge to a healthcare facility in survivors of septic shock. Prevention and treatment of volume overload in patients with septic shock warrants further investigation.
PMID: 26394090 [PubMed - as supplied by publisher]