Assessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock
| Autor: | Megan A. Van Berkel, Brittany R. Kiracofe-Hoyte, Heidi Riha, Amy Lehman, Eric J. Adkins, Rachel Wilkinson, Bruce Doepker, Elizabeth Rozycki |
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| Rok vydání: | 2020 |
| Předmět: |
Resuscitation
Critical Care and Intensive Care Medicine Lower risk Sepsis 03 medical and health sciences 0302 clinical medicine medicine Humans Dosing Hospital Mortality Obesity Prospective cohort study Retrospective Studies Septic shock business.industry Hemodynamics 030208 emergency & critical care medicine medicine.disease Shock Septic 030228 respiratory system Anesthesia Fluid Therapy business Body mass index Cohort study |
| Zdroj: | Journal of critical care. 63 |
| ISSN: | 1557-8615 |
| Popis: | Assess time to hemodynamic stability (HDS) in obese patients with septic shock who received30 vs. ≥30 ml/kg of initial fluid resuscitation based on actual body weight (ABW).Multicenter, retrospective, cohort analysis of 322 patients.Overall 216 (67%) patients received30 ml/kg of initial fluid resuscitation. Initial fluid received was lower in the30 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.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. |
| Databáze: | OpenAIRE |
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