Assessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock.

Autor: Kiracofe-Hoyte BR; Department of Pharmacy, Spectrum Health, 100 Michigan St. NE, Grand Rapids, MI 49503, United States of America. Electronic address: brittany.kiracofe@spectrumhealth.org., Doepker BA; Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 West 10(th) Ave., Columbus, OH 43210, United States of America., Riha HM; Department of Pharmacy, Ascension St. Elizabeth Hospital, 1506 S Oneida St., Appleton, WI 54915, United States of America., Wilkinson R; Department of Pharmacy, Fort Sanders Regional Medical Center, 1901 W Clinch Ave., Knoxville, TN 37916, United States of America., Rozycki E; Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 West 10(th) Ave., Columbus, OH 43210, United States of America., Adkins E; Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Ave., Columbus, OH 43210, United States of America., Lehman A; Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, 410 West 10th Ave., Columbus, OH 43210, United States of America., Van Berkel MA; Department of Pharmacy, Erlanger Health System, 975 E Third St., Chattanooga, TN 37403, United States of America.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2021 Jun; Vol. 63, pp. 196-201. Date of Electronic Publication: 2020 Sep 17.
DOI: 10.1016/j.jcrc.2020.09.006
Abstrakt: Purpose: Assess time to hemodynamic stability (HDS) in obese patients with septic shock who received <30 vs. ≥30 ml/kg of initial fluid resuscitation based on actual body weight (ABW).
Materials and Methods: Multicenter, retrospective, cohort analysis of 322 patients.
Results: Overall 216 (67%) patients received <30 ml/kg of initial fluid resuscitation. Initial fluid received was lower in the <30 ml/kg vs. ≥30 ml/kg group (16 vs. 37 ml/kg). The ≥30 ml/kg group had shorter time to HDS (multivariable p = 0.038) and lower riskof in-hospital death (multivariable p = 0.038). An exploratory subgroup analysis (n = 227) was performed, classifying patients by dosing strategy [ABW, adjusted body weight (AdjBW), ideal body weight (IBW)] based on fluid received at 3 h divided by 30 ml/kg. ABW dosed patients had a shorter time to HDS (multivariable p = 0.013) and lower risk of in-hospital death (multivariable p = 0.008) vs. IBW. Similar outcomes were observed between ABW vs. AdjBW.
Conclusions: Obese patients given ≥30 ml/kg based on ABW had a shorter time to HDS and a lower risk of in-hospital death. Exploratory results suggest improved outcomes resuscitating by ABW vs. IBW; ABW showed no strong benefit over AdjBW. Further prospective studies are needed to confirm the optimal fluid dosing in obese patients.
(Copyright © 2020. Published by Elsevier Inc.)
Databáze: MEDLINE
Externí odkaz: