Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study.

Autor: Acharya R; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America., Patel A; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America., Schultz E; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America., Bourgeois M; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America., Kandinata N; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America., Paswan R; Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America., Kafle S; RN-BSN Program, Fayetteville State University, Fayetteville, NC, United States of America., Sedhai YR; Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America., Younus U; Department of Critical Care Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Aug 19; Vol. 16 (8), pp. e0256368. Date of Electronic Publication: 2021 Aug 19 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0256368
Abstrakt: Background: The use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data.
Methods: The retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation.
Results: The use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82-0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93-1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90-0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus.
Conclusion: The use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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