Impact of Colloid Infusion on Outcomes in Patients with Septic Shock

Background: Although colloid solution has been widely used in practice, its impact on mortality in patients with septic shock remains unknown. We evaluated the association of colloid infusion with outcomes in septic shock patients.Methods: Medical Information Mart for Intensive Care (MIMIC)-III was used to identify patients with septic shock. Propensity score matching (PSM) was employed to balance the baseline differences. Cox proportional hazards model, Wilcoxon rank-sum test, and logistic regression were utilized to determine the associations of colloid infusion with mortality, length of stay, and recovery of kidney function, respectively.Results: A total of 4,553 septic shock patients were studied, including 1,158 with colloid infusion, and 3,395 without colloid infusion. After PSM, 1,012 pairs of patients were matched. Significant benefits in the mortality rate were observed in the colloid group compared with the non-colloid group, with the 28-day mortality [hazard ratio (HR) 0.62; 95% confidence interval [CI], 0.52-0.73; P < 0.001], and the 90-day mortality [HR 0.76; 95% CI 0.65-0.88; P < 0.001]. Colloid infusion was not associated with the renal function recovery [HR 1.06; 95% CI 0.87–1.29; P = 0.547] in either population. Nevertheless, subgroup analysis revealed that colloid infusion did not affect the 28-day mortality in people with sepsis of AKI stage 1. In addition, the use of dextran did not decrease the 28-day mortality (HR 1.41; 95% CI 0.19-10.59; P = 0.736). Conclusion: In septic shock patients, colloid infusion (albumin or hydroxyethyl starch) improved short-term survival, but had no clear effect on the recovery of renal function.

A Mini-fluid Challenge of 200 mL Predicts fluid Responsiveness Using Pulmonary Artery Catheter in Septic Shock Patients an Observational Study

Background: Mini-fluid challenge may predict fluid responsiveness and limit fluid overload. This study was designed to explore the minimal infusion volume in effectively predicting fluid responsiveness in septic shock patients.Methods: ICU septic shock patients with indwelling pulmonary artery catheter received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output was measured with thermodilution before fluid challenge (baseline) and three minutes after each bolus. Fluid responsiveness (FR) was defined as an increase in CO greater than 10% after 500 mL fluid infusion. The smallest volume which can perform an effective fluid challenge was analyzed. Results: Forty-seven patients were included in this prospective study. After 500 mL volume expansion, thirty-six patients presented with FR (77%) and 11 patients were fluid nonresponders. A mini fluid of 100 mL colloid had a poor predictive value (AUC = 0.67, p > 0.05). The minimal volume required to predict FR in a mini fluid challenge was 200 mL. An increase in CO greater than 5.2% after 200 mL colloid infusion was able to predict FR with a sensitivity of 83.3% and specificity of 90.9%. The AUC under the ROC curve was 0.93 (95% CI: 0.84 – 1, p < 0.05). Conclusion: In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders and nonresponders.Trial registration: ClinicalTrial.gov (NCT01941472). Registered on 13 September 2013.