Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: A case control study
| Autor: | Sami Pervaiz, Suzanne El-Sayegh, Saad Habib, Benjamin Mann, Abdul Hasan Siddiqui, Bino Joseph, Seleshi Demissie, Gurkirat Sandhu, Lazer Leifer, Kartikeya Rajdev |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Resuscitation medicine.medical_specialty Surviving Sepsis Campaign medicine.medical_treatment Early goal-directed therapy Critical Care and Intensive Care Medicine End stage renal disease law.invention Sepsis 03 medical and health sciences 0302 clinical medicine Renal Dialysis law medicine Humans Vasoconstrictor Agents Hospital Mortality Aged Aged 80 and over Heart Failure Septic shock business.industry 030208 emergency & critical care medicine Length of Stay Middle Aged medicine.disease Respiration Artificial Shock Septic Intensive care unit Intensive Care Units 030228 respiratory system Case-Control Studies Multivariate Analysis Emergency medicine Fluid Therapy Kidney Failure Chronic Female Hemodialysis business |
| Zdroj: | Journal of Critical Care. 55:157-162 |
| ISSN: | 0883-9441 |
| Popis: | Due to the potential risk of volume overload, physicians are hesitant to aggressively fluid-resuscitate septic patients with end-stage renal disease (ESRD) on hemodialysis (HD). Primary objective: To calculate the percentage of ESRD patients on HD (Case) who received ≥30 mL/Kg fluid resuscitation within the first 6 h compared to non-ESRD patients (Control) that presented with severe sepsis (SeS) or septic shock (SS). Secondary objectives: Effect of fluid resuscitation on intubation rate, need for urgent dialysis, hospital length of stay (LOS), intensive care unit (ICU) admission and LOS, need for vasopressors, and hospital mortality. Medical records of 715 patients with sepsis, SeS, SS, and ESRD were reviewed. We identified 104 Case and 111 Control patients. In the Case group, 23% of patients received ≥30 mL/Kg fluids compared to 60% in the Control group (p 0.001). There was no significant difference in in-hospital mortality, need for urgent dialysis, intubation rates, ICU LOS, or hospital LOS between the two groups. Subgroup analysis between ESRD patients who received ≥30 mL/Kg (N = 80) vs those who received30 mL/Kg (N = 24) showed no significant difference in any of the secondary outcomes. Compliance with 30 mL/Kg fluids was low for all patients but significantly lower for ESRD patients. Aggressive fluid resuscitation appears to be safe in ESRD patients. |
| Databáze: | OpenAIRE |
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