Survey of non-resuscitation fluids administered during septic shock: a multicenter prospective observational study
| Autor: | John H. Boyd, Mårten Jungner, Adam Oscarson, Martin Spångfors, Sally H.J. Choi, Johan Undén, Mohammed Jan, Peter Bentzer, Donald E. G. Griesdale, Thomas Kander, Anja Lindén-Søndersø |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Resuscitation Critical Care and Intensive Care Medicine Vehicle law.invention 03 medical and health sciences 0302 clinical medicine Interquartile range law Vasoactive Anesthesiology Intensive care Septic shock medicine business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 medicine.disease Intensive care unit Non-resuscitation fluids Fluid balance 030228 respiratory system Anesthesia Observational study business |
| Zdroj: | Annals of Intensive Care, Vol 9, Iss 1, Pp 1-7 (2019) Annals of Intensive Care |
| DOI: | 10.14288/1.0386015 |
| Popis: | Background The indication, composition and timing of administration of non-resuscitation fluid in septic shock have so far received little attention and accordingly the potential to reduce this source of fluid is unknown. The objective of the study was to quantify and characterize non-resuscitation fluid administered to patients with septic shock. Methods This prospective observational study was performed in eight intensive care units in Sweden and Canada during 4 months in 2018. Adult patients with septic shock within 24 h of admission to the intensive care unit were eligible for inclusion. Non-resuscitation fluids were defined as fluids other than colloids, blood products and crystalloids at a rate ≥ 5 ml/kg/h. Indication, volume and type of fluid were recorded during the first 5 days after admission. A maximum of 30 patients could be included per centre. To estimate the potential to reduce administration of non-resuscitation fluid, a pragmatic “restrictive” protocol for administration of non-resuscitation fluids was devised based on the most restrictive practice already in place for non-resuscitation fluids at any of the participating centres. Data are presented as median (interquartile range [IQR]). Results A total of 200 patients were included in the study and the 30-day mortality was 35%. Patients received a total of 7870 (4060–12,340) ml of non-resuscitation fluids and 2820 (1430–4580) of resuscitation fluids during the observation period. Median volumes of non-resuscitation and resuscitation fluids were similar at day 1 (1620 [710–2320] and 1590 [520–3000]) ml, respectively) and non-resuscitation fluids represented the largest source of fluid from day 2 and onwards after admission to the ICU. Vehicles for drugs such as vasoactive drugs and antibiotics constituted the largest fraction of non-resuscitation fluids (2400 [1270–4030] ml) during the 5-day observation period. Modelling suggested that volume of non-resuscitation fluids could be reduced by 2840 (1270–4900) ml during the first 5 days of admission to the ICU, mainly through reducing maintenance fluids. Conclusions Non-resuscitation fluids constitute the major fraction of fluids administered in the ICU to patients suffering from septic shock and may represent the largest modifiable target to reduce fluid overload. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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