Comparison of fluid resuscitation weight-based dosing strategies in obese patients with severe sepsis - 29/10/21
, Rusha Patel a , Calvin Tucker a , Marie-Carmelle Elie b , Benjamin J. Staley a , Nicolas Tran c, Steve Lemon a Abstract |
Objective |
This study aims to compare the composite outcome of progression to septic shock between 30 mL/kg/ideal body weight (IBW) versus 30 mL/kg/non-IBW fluid resuscitation dosing strategies in obese patients with severe sepsis.
Methods |
We retrospectively evaluated obese patients admitted to an academic tertiary care center for the management of severe sepsis. Patients were included if they had a fluid bolus order placed using the sepsis order set between Oct 2018 and Sept 2019. The primary objective was the composite of progression to septic shock, defined as either persistent hypotension within 3 h after the conclusion of the 30 mL/kg fluid bolus administration or the initiation of vasopressor(s) within 6 h of the bolus administration.
Results |
Of 72 included patients, 49 (68%) were resuscitated using an IBW-based and 23 (32%) using a non-IBW-based dosing strategy. There were similar rates of progression to septic shock in the IBW and non-IBW groups (18% vs. 26%; p = 0.54). Median ICU and hospital LOS in the IBW group versus non-IBW group were (0 [IQR 0] vs. 0 [IQR 0 to 4] days; p = 0.13) and (6 [IQR 3 to 10] vs. 8 [IQR 5 to 12] days; p = 0.07), respectively. In-hospital mortality rates were similar between the groups.
Conclusions |
Our study results suggest that in obese septic patients, fluid administration using an IBW-dosing strategy did not affect the progression to septic shock.
Le texte complet de cet article est disponible en PDF.Highlights |
• | 30 mL/kg/IBW bolus did not affect progression to shock in obese septic patients. |
• | In-hospital mortality rates and length of hospitalization days were similar. |
• | No differences were found in rates of diuresis or renal replacement therapy. |
• | In first 12 h post-severe sepsis, non-IBW arm received higher fluid volumes. |
• | Prospective trials are warranted to evaluate need for mechanical ventilation using IBW and non-IBW fluid dosing strategies. |
Keywords : Sepsis, Shock, Obesity, Fluid therapy, Hemodynamics
Plan
Vol 49
P. 268-272 - novembre 2021 Retour au numéro
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