Septic shock is an urgent clinical condition that requires immediate medical attention. Early, rapid resolution of hypotension is one of the key tenets in preventing deleterious outcomes such as organ failure and mortality.¹ Studies have shown that earlier resuscitation can lead to reversal of hypotension and shock,2,3,4 which can result in shorter stays in the ICU, fewer mechanical ventilations, and fewer in-hospital mortalities.5 One such study found that patients with IV fluid resuscitation initiated within 30 minutes of severe sepsis or septic shock identification had a lower mortality (13% receiving ≤30-minute fluid intervention vs 18.3% receiving >30-minute fluid intervention) and a significantly shorter hospital length of stay compared with patients who were resuscitated beyond 30 minutes.3 Another study demonstrated that fluid initiation in less than 30 minutes was associated with reduced need for mechanical ventilation, significantly lower hospital mortality, ICU admission, length of stay, and ICU days.6
These data provide strong evidence for early fluid resuscitation. However, providers are often unable to achieve fluid delivery guidelines using current techniques.5 Current methods of fluid resuscitation (gravity infusion, IV infusion pumps, mechanical rapid infusers, manual syringes, and pressure bags) have limitations. It can take 20 or more minutes to deliver 1L IV fluid bolus with a pressure bag, and flow rates are highly dependent on both catheter size and user re-inflation of the bag. Moreover, there are numerous reports of air embolisms associated with pressure bag use.7,8,9 When utilized, the push-pull method is labor-intensive10 and may increase the risk of contamination through non-sterile syringe contact.11 These complexities often result in a limited ability to successfully administer early fluids, hence increasing the potential for complications and thus, higher treatment costs.
Time-to-first-bolus and volume control can improve markedly when LifeFlow, an innovative new device for rapid delivery of a fluid bolus, is used to administer fluids. Studies have shown in a simulated emergency shock patient that LifeFlow is faster12 and less stressful7 than traditional rapid fluid resuscitation techniques. LifeFlow can be set up and deliver 500 ml in less than 4 minutes,13 up to 10 times faster than other methods.13,14
Significant decreases in hospital and ICU lengths of stay were observed in patients when timely fluid delivery was administered in concurrence with bundle adherence.15 When compared to standard IV fluid delivery methods in an analytical model, providers using the LifeFlow device can experience increased overall bundle compliance of 50–90%.5 Consequently, patient outcomes for every 500 patients are projected to notably improve, with the use of LifeFlow resulting in:
•Ten lives saved
•Lower required use of mechanical ventilation: 24% vs 31%
•Decreased average length of stay: 11 vs 13 days
•Decreased average intensive care unit length of stay: 2 vs 3 days
•Decreased use of vasopressors: 17% vs 21%
While the primary goal of resuscitation is to save and improve the quality of the septic patient’s life, it is also important to look at the economic implications of early, rapid resuscitation. The same analytical model that revealed improvements to patient care with the LifeFlow device (for 500 patients versus standard fluid delivery methods) also showed considerable cost implications, including:
•Reduced overall hospital costs of $1,569,131 (USD)
•Reduced total hospital stay of 455 days
•Fewer patients admitted to ICU
•Reduced total ICU stay of 121 days
Even under the most conservative model assumptions, these findings suggest that LifeFlow has the potential to save lives and significantly reduce hospital costs. 5 These cost savings are primarily due to shorter inpatient hospital stays, reduced ICU admissions, and other related costs influenced by increased protocol compliance associated with early, rapid fluid delivery.5
There is a significant body of evidence supporting early fluids for sepsis patients, demonstrating improved outcomes, less ICU admissions, and reduced need for interventions. When compared to complicated and cumbersome standard fluid delivery methods, LifeFlow offers significantly faster and more controlled IV fluid resuscitation, which can lead to improved sepsis bundle compliance. These factors, along with published analytic model data,5 suggest that LifeFlow may lead to significant hospital and patient cost savings in sepsis care.
Interested in learning more about rapid, controlled delivery of a fluid bolus with LifeFlow? Contact us.
- Rivers E, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377.
- Lee S, et al. (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.
- Leisman, D., et al. (2016). Association of Fluid Resuscitation Initiation Within 30 Minutes of Severe Sepsis and Septic Shock Recognition With Reduced Mortality and Length of Stay. Ann Emerg Med 68(3): 298-311.
- Williams JM, et al.(2018). “Characteristics, treatment and outcomes for all emergency department patients fulfilling criteria for septic shock: a prospective observational study.” Eur J Emerg Med 25(2): 97-104.
- Brooks EA, Piehl M. (2018). “Potential mortality and cost reduction in adult severe sepsis and septic shock through the use of an innovative fluid delivery device.” Open Access Emer Med. 10 165–170.
- Leisman D, et al. (2017). Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort. Crit Care Med. Oct;45(10):1596-1606.
- Kline M., et al. (2018). A Randomized Single-Blinded Simulation-Based Trial of a Novel Method for Fluid Administration to a Septic Infant. Pediatric Emergency Care.
- Adinarayanan S, et al. (2016). Massive air embolism through a peripheral venous cannula. Brit Jour of Anaes. 109.
- Bakan M, et al. (2013). Inadvertent venous air embolism during cesarean section: collapsible intravenous fluid bags without self-sealing outlet have risks. Case report. Braz J Anes. 63:362-365.
- Shamim F, et al. (2016). Fatal vascular air embolism during fluid resuscitation as a complication of pressure infuser bag. J Emerg Trauma Shock. 9:46-47.
- Spangler H, et al. (2019). Improving Aseptic Technique During the Treatment of Pediatric Septic Shock: A Comparison of 2 Rapid Fluid Delivery Methods. Jour of Infusion Nursing. Jan/Feb; Vol 42, No 1: 23–28.
- Robertson, G., Lane, A., Piehl, M., Whitfill, T., Spangler, H. (2018) Comparison of a novel rapid fluid delivery device to traditional methods. [White paper]. Data in Table 1.
- Data on file, 410 Medical.
- Becton, Dickinson and Company. Alaris™ Pump module FAQs. Issued 15 July 2016.
- Paul, R et al. (2012) Adherence to PALS Sepsis Guidelines and Hospital Length of Stay. Pediatrics. e273-e280.