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Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study.
Chest. 2014 Oct; 146(4):908-915.Chest

Abstract

BACKGROUND

The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time.

METHODS

This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009. Data were collected from a previously validated electronic medical database. Multivariate regression modeling was performed, adjusting for age, admission weight, Sequential Organ Failure Assessment score, APACHE (Acute Physiology and Chronic Health Examination) III score, and total fluid administration within the first 6 h of sepsis onset time.

RESULTS

Of 651 patients with severe sepsis and septic shock screened, 594 had detailed fluid data. In a univariate analysis, the median amount of fluid within the first 3 h for survivors at discharge was 2,085 mL (940-4,080 mL) and for nonsurvivors, 1,600 mL (600-3,010 mL; P = .007). In comparison, during the latter 3 h, the median amount was 660 mL (290-1,485 mL) vs 800 mL (360-1,680 mL; P = .09), respectively. After adjusting for confounders, the higher proportion of total fluid received within the first 3 h was associated with decreased hospital mortality (OR, 0.34; 95% CI, 0.15-0.75; P = .008).

CONCLUSIONS

Earlier fluid resuscitation (within the first 3 h) is associated with a greater number of survivors with severe sepsis and septic shock.

Authors+Show Affiliations

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Kashyap.Rahul@mayo.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24853382

Citation

Lee, Sarah J., et al. "Increased Fluid Administration in the First Three Hours of Sepsis Resuscitation Is Associated With Reduced Mortality: a Retrospective Cohort Study." Chest, vol. 146, no. 4, 2014, pp. 908-915.
Lee SJ, Ramar K, Park JG, et al. Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study. Chest. 2014;146(4):908-915.
Lee, S. J., Ramar, K., Park, J. G., Gajic, O., Li, G., & Kashyap, R. (2014). Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study. Chest, 146(4), 908-915. https://doi.org/10.1378/chest.13-2702
Lee SJ, et al. Increased Fluid Administration in the First Three Hours of Sepsis Resuscitation Is Associated With Reduced Mortality: a Retrospective Cohort Study. Chest. 2014;146(4):908-915. PubMed PMID: 24853382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study. AU - Lee,Sarah J, AU - Ramar,Kannan, AU - Park,John G, AU - Gajic,Ognjen, AU - Li,Guangxi, AU - Kashyap,Rahul, PY - 2014/5/24/entrez PY - 2014/5/24/pubmed PY - 2014/12/15/medline SP - 908 EP - 915 JF - Chest JO - Chest VL - 146 IS - 4 N2 - BACKGROUND: The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time. METHODS: This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009. Data were collected from a previously validated electronic medical database. Multivariate regression modeling was performed, adjusting for age, admission weight, Sequential Organ Failure Assessment score, APACHE (Acute Physiology and Chronic Health Examination) III score, and total fluid administration within the first 6 h of sepsis onset time. RESULTS: Of 651 patients with severe sepsis and septic shock screened, 594 had detailed fluid data. In a univariate analysis, the median amount of fluid within the first 3 h for survivors at discharge was 2,085 mL (940-4,080 mL) and for nonsurvivors, 1,600 mL (600-3,010 mL; P = .007). In comparison, during the latter 3 h, the median amount was 660 mL (290-1,485 mL) vs 800 mL (360-1,680 mL; P = .09), respectively. After adjusting for confounders, the higher proportion of total fluid received within the first 3 h was associated with decreased hospital mortality (OR, 0.34; 95% CI, 0.15-0.75; P = .008). CONCLUSIONS: Earlier fluid resuscitation (within the first 3 h) is associated with a greater number of survivors with severe sepsis and septic shock. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/24853382/Increased_fluid_administration_in_the_first_three_hours_of_sepsis_resuscitation_is_associated_with_reduced_mortality:_a_retrospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)33172-X DB - PRIME DP - Unbound Medicine ER -