In this month’s issue of Chest, Khan & colleagues provide further evidence on the safety of guideline-recommended fluid resuscitation in chronically ill patients with septic shock.1
Consistent with several other recent papers on this topic, the authors showed that 30ml/kg of initial crystalloid resuscitation is well tolerated in patients with CHF, ESRD, and cirrhosis and, importantly, does not increase the need for intubation in these patients.
Patients with chronic illness, particularly heart failure and renal failure, are less likely to receive initial adequate fluid resuscitation due to the perception that they are at increased risk of fluid overload and respiratory failure.2 It appears that the opposite is actually true: patients with perceived risk factors actually have lower mortality and need for mechanical ventilation when they receive 30ml/kg early in the course of their disease.2-4 In fact, this population may benefit the most from earlier and adequate fluid resuscitation for septic shock.4
Khan rightly points out that the Surviving Sepsis Campaign 30ml/kg guidelines are focused on early resuscitation and reversal of shock, not positive cumulative fluid balance in the ICU, which is known to be harmful.
Dr. Khan and co-author Dr. Reddy have a helpful podcast here explaining the study results and their interpretation of the findings.
- Khan RA, Khan NA, Bauer SR, et al. Association Between Volume of Fluid Resuscitation and Intubation in High-Risk Patients With Sepsis, Heart Failure, End-Stage Renal Disease, and Cirrhosis. Chest. 2020;157(2):286-292. doi:10.1016/j.chest.2019.09.029
- Kuttab HI, Lykins JD, Hughes MD, et al. Evaluation and predictors of fluid resuscitation in patients with severe sepsis and septic shock. Crit Care Med. 2019;47(11):1582-1590. doi:10.1097/CCM.0000000000003960
- Leisman DE, Doerfler ME, Ward MF, et al. Survival Benefit and Cost Savings From Compliance With a Simplified 3-Hour Sepsis Bundle in a Series of Prospective, Multisite, Observational Cohorts. Crit Care Med. 2017;45(3):395-406. doi:10.1097/CCM.0000000000002184
- Liu VX, Morehouse JW, Marelich GP, et al. Multicenter Implementation of a Treatment Bundle for Patients with Sepsis and Intermediate Lactate Values. Am J Respir Crit Care Med.