scholarly journals Positive fluid balance and prognostic factors of ICU mortality in patients admitted with septic shock

Critical Care ◽  
2014 ◽  
Vol 18 (S2) ◽  
Author(s):  
W Koonrangsesomboon ◽  
B Khwannimit
Keyword(s):  
Septic Shock ◽  
Prognostic Factors ◽  
Fluid Balance ◽  
Positive Fluid Balance ◽  
Icu Mortality

scholarly journals Association of Positive Fluid Balance and Mortality in Sepsis and Septic Shock in An Australian Cohort

2017 ◽  
Vol 45 (6) ◽  
pp. 737-743 ◽  
Author(s):  
M. G. Pittard ◽  
S. J. Huang ◽  
A. S. McLean ◽  
S. R. Orde
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Confidence Intervals ◽  
Fluid Balance ◽  
Severity Of Illness ◽  
Primary Outcome Measure ◽  
Published Data ◽  
Positive Fluid Balance ◽  
Retrospective Audit ◽  
Sepsis And Septic Shock

In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fluid balance for the first seven days of ICU admission, biochemical data and other clinical indices. The primary outcome measure was survival to hospital discharge. One hundred and eighty-six patients with septic shock were included, with an overall hospital mortality of 23.7%. Seventy-five percent of patients required mechanical ventilation, and 27.4% required haemodialysis. The mean daily fluid balance on the first day of admission was positive 1,424 ml and 1,394 ml for ICU and hospital survivors, respectively. On average, the daily fluid balance for non-survivors was higher than the survivors: ICU non-survivors were 602 (95% confidence intervals 230, 974) ml (P=0.0015) and hospital non-survivors were 530 [95% confidence intervals 197, 863] ml (P=0.0017) higher than the survivors. In line with other recently published data, after adjustment for confounders (severity of illness based on the Acute Physiology and Chronic Health Evaluation score) we found a correlation between positive fluid balance and worsened hospital mortality in critically ill patients with sepsis and septic shock. Further research investigating rational use of fluids in this patient group is needed.

Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock

2015 ◽  
Vol 30 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Fernando Saes Vilaça de Oliveira ◽  
Flavio Geraldo Resende Freitas ◽  
Elaine Maria Ferreira ◽  
Isac de Castro ◽  
Antonio Toneti Bafi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Prognostic Factor ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Positive Fluid Balance ◽  
Sepsis And Septic Shock

Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge

2016 ◽  
Vol 34 (11) ◽  
pp. 2122-2126 ◽  
Author(s):  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Ronen Toledano ◽  
Abraham Borer ◽  
Lior Fucs ◽  
...  
Keyword(s):  
Septic Shock ◽  
Clinical Outcome ◽  
Fluid Balance ◽  
Positive Fluid Balance ◽  
Icu Discharge ◽  
Major Predictor

scholarly journals A Nationwide Comparison Between Sepsis-2 and Sepsis-3 Definition in Japan

2019 ◽  
Vol 35 (12) ◽  
pp. 1389-1395 ◽  
Author(s):  
Shuhei Takauji ◽  
Mineji Hayakawa ◽  
Satoshi Fujita
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Prognostic Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Chronic Hemodialysis ◽  
Shock Group ◽  
Sepsis Group ◽  
Icu Mortality ◽  
Chronic Heart Disease ◽  
Significant Difference

Background: Currently, it remains controversial whether the Sepsis-3 definition provides the most appropriate criteria for clinical use. The purpose of this study was to compare between the Sepsis-2 and Sepsis-3 definitions using Japan’s nationwide registry. Methods: Data were obtained from a multicenter registry conducted at 42 intensive care units (ICUs) throughout Japan, in which patients received treatment for severe sepsis or septic shock between January 2011 and December 2013. Results: A total of 2797 patients diagnosed using the Sepsis-2 criteria were included in the present study. These patients were categorized into “Severe sepsis” (n = 1154) and “Sepsis-2 shock” (n = 1643) groups. Among the “Sepsis-2 shock” group, patients who did not meet the Sepsis-3 criteria for septic shock were categorized into the “Sepsis-2 shock-only” (n = 448, 27.3%) group, while patients who met the Sepsis-3 criteria for septic shock were categorized into “Sepsis-3 shock (n = 1195, 72.7%)” group. The ICU mortality in the “Sepsis-3 shock” group, “Sepsis-2 shock-only” group, and “Severe sepsis” group was 28.5%, 10.9%, and 14.1%, respectively. We observed no significant difference between the “Severe sepsis” and “Sepsis-2 shock-only” groups in terms of in-hospital survival ( P = .098), while the “Sepsis-3 shock” group had the highest in-hospital mortality rate ( P < .001). In a multivariate logistic regression analysis, liver insufficiency and immunocompromised status were independent prognostic factors in the “Sepsis-2 shock-only” group. In contrast, chronic heart disease and chronic hemodialysis were independent prognostic factors in the “Sepsis-3 shock” group. Conclusions: The ICU mortality of the “Sepsis-2 shock-only” group was significantly low. Besides septic shock diagnosed by the Sepsis-3 definition selects patients with more severe cases of sepsis among the “Sepsis-2 shock” group.

Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist

2019 ◽  
Vol 54 (4) ◽  
pp. 388-396
Author(s):  
Brittany D. Bissell ◽  
Breanne Mefford
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Patient Care ◽  
Fluid Balance ◽  
Clinical Pharmacist ◽  
Improve Patient Care ◽  
Positive Fluid Balance ◽  
Medline Search ◽  
Icu Stay ◽  
Organ Systems

Objective: To review physiological rationale and evidence base surrounding fluid harm to prepare the clinical pharmacist for accountability regarding volume-related outcomes. Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (fluid therapy) AND [(critical care) OR (sepsis)] from 1966 to August 2019 published in English. Study Selection and Data Extraction: A total of 3364 citations were reviewed with only relevant clinical data extracted. Data Synthesis: Although early fluid resuscitation may be a necessary component to decrease mortality in the majority of patients with septic shock admitted to the intensive care unit (ICU), the benefit of continued administration after the first 24 hours is uncertain. Paradoxically, a positive fluid balance secondary to intravenous fluid receipt has been associated with diverse and perpetuating detriment on a multitude of organ systems after the first 24 hours of ICU stay. Continued clinical harm has been demonstrated on patient outcomes such as rates of mortality and length of stay. Despite the growing body of evidence supporting the potential adverse aspects of positive fluid balance, fluid overload remains common during critical care admission. Conclusion: Physiological concerns to overly zealous fluid administration and subsequent volume overload are vast. Relevance to Patient Care and Clinical Practice: Optimization of fluid balance in critically ill patients with sepsis is primed for clinical pharmacy intervention. Critical care pharmacists have the potential to improve patient care by optimizing fluid pharmacotherapy while potentially reducing adverse events, days on mechanical ventilation, and length of ICU stay.

scholarly journals The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review

2020 ◽  
Vol 48 (1) ◽  
pp. 11-24
Author(s):  
Timothy G Scully ◽  
Yifan Huang ◽  
Stephen Huang ◽  
Anthony S McLean ◽  
Sam R Orde
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Fluid Balance ◽  
Fluid Therapy ◽  
Transpulmonary Thermodilution ◽  
Venous Pressure ◽  
Positive Fluid Balance ◽  
Central Venous ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy

Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.

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