Is Receiving Early Fluid Resuscitation Safe in Sepsis With Comorbidities?

Early fluid resuscitative efforts are important in patients with cirrhosis, congestive heart failure (CHF), or end-stage renal disease (ESRD) with sepsis to prevent acute respiratory failure, according to the results of a retrospective study published in CHEST.

Septic shock is an important cause of significant morbidity and mortality in critical care units, and for patients in septic shock who have a comorbidity (eg, CHF, ESRD, or cirrhosis) that puts them at risk for volume overload, there is uncertainty in fluid resuscitation tolerance and concern for subsequent development of acute respiratory failure.

Researchers assessed the association between 30 mL/kg crystalloids and intubation in patients with sepsis or septic shock and CHF, ESRD, or cirrhosis. In this study, primary exposure was intravenous fluid volume within the first 6 hours after sepsis diagnosis. Two groups were identified: those with fluid volume ≥30 mL/kg (standard group; n=104) and those with fluid volume <30 mL/kg (restricted group; n=104). The researchers observed no difference in intubation incidence between the standard and restricted groups (33 vs 36, respectively; P.64) or in alive intensive care unit-free days (17±11 days vs 17±10 days, P=.64), duration of mechanical ventilation (10±12 days vs 11±16 days, P=.96), or hours to intubation (16±19 hours vs 14±15, P =.55).

“In conclusion, we did not detect a difference in the incidence of intubation in the high-risk cohort of cirrhotic, heart failure, and ESRD patients with sepsis who received [Surviving Sepsis Campaign] guideline-concordant (30 mL/kg) vs restricted fluid resuscitation,” the researchers wrote. “Based on our results, we suggest that guideline based early fluid resuscitative efforts should not be omitted in patients with cirrhosis, CHF, and ESRD solely for concern of acute respiratory failure.”

Reference

Khan RA, Khan NA, Bauer SR, et al. Association between volume of fluid resuscitation and intubation in high-risk patients with sepsis, heart failure, end-stage renal disease, and cirrhosis [published online October 14, 2019]. CHEST. doi:10.1016/j.chest.2019.09.029