Background:Fluid resuscitation is a key treatment for sepsis,but limited data exists in patients with existing heartfailure(HF)and septic shock.The objective of this study was to determine the impact of initial fluid ...Background:Fluid resuscitation is a key treatment for sepsis,but limited data exists in patients with existing heartfailure(HF)and septic shock.The objective of this study was to determine the impact of initial fluid resuscitationvolume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction(LVEF)withseptic shock.Methods:This multicenter,retrospective,cohort study included patients with known HF(LVEF≤50%)presentingwith septic shock.Patients were divided into two groups based on the volume of fluid resuscitation in the first 6 h;<30 mL/kg or≥30 mL/kg.The primary outcome was a composite of in-hospital mortality or renal replacementtherapy(RRT)within 7 days.Secondary outcomes included acute kidney injury(AKI),initiation of mechanicalventilation,and length of stay(LOS).All related data were collected and compared between the two groups.A generalized logistic mixed model was used to assess the association between fluid groups and the primaryoutcome while adjusting for baseline LVEF,Acute Physiology and Chronic Health Evaluation(APACHE)II score,inappropriate empiric antibiotics,and receipt of corticosteroids.Results:One hundred and fifty-four patients were included(93 patients in<30 mL/kg group and 61 patientsin≥30 mL/kg group).The median weight-based volume in the first 6 h was 17.7(12.2–23.0)mL/kg in the<30 mL/kg group vs.40.5(34.2–53.1)mL/kg in the≥30 mL/kg group(P<0.01).No statistical difference was detected in the composite of in-hospital mortality or RRT between the<30 mL/kg group compared to the≥30 mL/kggroup(55.9%vs.45.9%,P=0.25),respectively.The<30 mL/kg group had a higher incidence of AKI,mechanicalventilation,and longer hospital LOS.Conclusions:In patients with known reduced or mildly reduced LVEF presenting with septic shock,no differencewas detected for in-hospital mortality or RRT in patients who received≥30 mL/kg of resuscitation fluid comparedto less fluid,although this study was underpowered to detect a difference.Importantly,≥30 mL/kg fluid did notresult in a higher need for mechanical ventilation.展开更多
文摘Background:Fluid resuscitation is a key treatment for sepsis,but limited data exists in patients with existing heartfailure(HF)and septic shock.The objective of this study was to determine the impact of initial fluid resuscitationvolume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction(LVEF)withseptic shock.Methods:This multicenter,retrospective,cohort study included patients with known HF(LVEF≤50%)presentingwith septic shock.Patients were divided into two groups based on the volume of fluid resuscitation in the first 6 h;<30 mL/kg or≥30 mL/kg.The primary outcome was a composite of in-hospital mortality or renal replacementtherapy(RRT)within 7 days.Secondary outcomes included acute kidney injury(AKI),initiation of mechanicalventilation,and length of stay(LOS).All related data were collected and compared between the two groups.A generalized logistic mixed model was used to assess the association between fluid groups and the primaryoutcome while adjusting for baseline LVEF,Acute Physiology and Chronic Health Evaluation(APACHE)II score,inappropriate empiric antibiotics,and receipt of corticosteroids.Results:One hundred and fifty-four patients were included(93 patients in<30 mL/kg group and 61 patientsin≥30 mL/kg group).The median weight-based volume in the first 6 h was 17.7(12.2–23.0)mL/kg in the<30 mL/kg group vs.40.5(34.2–53.1)mL/kg in the≥30 mL/kg group(P<0.01).No statistical difference was detected in the composite of in-hospital mortality or RRT between the<30 mL/kg group compared to the≥30 mL/kggroup(55.9%vs.45.9%,P=0.25),respectively.The<30 mL/kg group had a higher incidence of AKI,mechanicalventilation,and longer hospital LOS.Conclusions:In patients with known reduced or mildly reduced LVEF presenting with septic shock,no differencewas detected for in-hospital mortality or RRT in patients who received≥30 mL/kg of resuscitation fluid comparedto less fluid,although this study was underpowered to detect a difference.Importantly,≥30 mL/kg fluid did notresult in a higher need for mechanical ventilation.
