By broadly defining respiratory failure to include an increase in oxygen requirements, a conservative initial intravenous (IV) fluids resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure in patients with sepsis, according to the results of a single-center retrospective study published in CHEST.

Since the first publication of the Surviving Sepsis Campaign (SSC), early, aggressive IV fluid administration has been the cornerstone of sepsis management. However, consensus regarding its association with improvement in clinical outcomes is lacking. Therefore, researchers sought to determine whether there is a difference in the incidence of respiratory failure in patients with sepsis who received a guideline-recommended initial IV fluid bolus of 30 cc/kg vs a more conservative resuscitation of fewer than 30 cc/kg. The researchers performed a retrospective analysis of prospectively collected clinical data from 214 patients with sepsis admitted to a single academic medical center between June 2017 and June 2018 in Omaha, Nebraska.

A total of 62 (29.0%) patients received a guideline-recommended fluid bolus. However, the overall rate of respiratory failure was not statistically different between patients who received an appropriate bolus or not (40.3% vs 36.8%, P =.634). Likewise, no differences were observed in time-to-respiratory failure (P =.645) or risk of respiratory failure (P =.774). Subgroup analyses were conducted in high-risk patients with congestive heart failure (CHF) as well as those with chronic kidney disease (CKD) and results were similar in these subgroups.


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“In this single-center retrospective study we found that rates of compliance with the SSC guidelines are low in patients with CHF and/or renal disease — those most at-risk for iatrogenic fluid overload,” the study authors wrote. “However, this conservative strategy appears unfounded as the rate of respiratory failure was similar regardless of whether patients received appropriate or conservative resuscitation.”

Reference

Jagan N, Morrow LE, Walters RW, et al. Sepsis, the administration of intravenous fluids and respiratory failure: a retrospective analysis – SAIFR Study. CHEST. Published online November 13, 2020. doi:10.1016/j.chest.2020.10.078