Emergency Preparedness Considerations and Guidance: Fluid Resuscitation for Septic Shock Resulting from COVID-19

 

WHO recommendations for suspected COVID-19 patients with septic shock:
  • Adults: 250–500 mL crystalloid fluid and reassess after each bolus
  • Children: 10–20 mL/kg crystalloid fluid and reassess after each bolus

Septic shock is a life-threatening condition that can occur when a secondary bacterial infection develops in the setting of a severe respiratory illness such as influenza or COVID-19.  According to recent reports on hospitalized COVID-19 patients in China, up to 35% develop shock, and sepsis and septic shock have been identified in a majority of non-survivors.1-3  Guidance from the World Health Organization (WHO) on COVID-19 identifies septic shock as a critical concern and recommends continuing to follow standard therapy for septic shock, which includes adequate early fluid resuscitation.4  Since some critically ill COVID-19 patients have evidence of myocardial injury and most develop severe pneumonia or ARDS, newly updated Surviving Sepsis Campaign COVID-19 guidelines advise careful bedside assessment of fluid responsiveness to avoid fluid overload in the ICU. 3 WHO guidelines recommend controlled fluid resuscitation using crystalloid fluid boluses of 250-500mL to reverse acute shock, with frequent bedside monitoring of patient response following each bolus.4        

LifeFlow is a single-use, hand-powered, and portable rapid fluid infuser that can be an ideal tool in managing critically ill patients in multiple settings.  LifeFlow allows the user to carefully titrate the volume of fluid administered, enabling providers to rapidly resuscitate with continuous assessment while reducing the risk of fluid overload for patients with severe respiratory illness.  LifeFlow offers quick setup and the ability to deliver a 250ml bolus in <1 minute, leading to rapid reversal of shock and hypotension, and providing immediate feedback on fluid responsiveness with less total volume infused, allowing earlier identification of patients who need vasopressors.

Early and targeted fluid resuscitation for septic shock reduces risk of endotracheal intubation, shortens duration of mechanical ventilation, decreases organ injury and hospital length of stay, and saves lives.5-7    In fact, patients who receive their fluid bolus early in their course of treatment have shown the lowest likelihood of requiring endotracheal intubation.This could be particularly important during the COVID-19 pandemic, where up to half of hospitalized patients developed respiratory failure.1 In hospitals experiencing a sudden influx of critically ill patients, immediate response to those with hypovolemic shock or suspected sepsis may be a key factor in stabilizing patients and reducing subsequent complications, including death.

As hospitals prepare for the COVID-19 pandemic, LifeFlow can be a tool for managing and treating large numbers of patients in contact and droplet isolation rooms and emergency triage facilities needing rapid and measured fluid delivery for septic shock.

Interested in learning more about LifeFlow? Contact us.

References

  1. Zhou F, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 9 March 2020. doi: 10.1016/S0140-6736(20)30566-3.
  2. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. February 2020. doi: 10.1001/jama.2020.1585.
  3. Alhazzani W, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med 2020. https://www.sccm.org/getattachment/Disaster/SSC-COVID19-Critical-Care-Guidelines.pdf?lang=en-US.
  4. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim Guidance. World Health Organization. 13 March 2020. Pg. 9. WHO/2019-nCoV/clinical/2020.4.
  5. Lee SJ, et al. (2014). 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. doi: 10.1378/chest.13-2702.  
  6. Leisman D, et al. 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. 2016 Sep;68(3): 298-311. doi: 10.1016/j.annemergmed.2016.02.044.
  7. Williams JM, et al. “Characteristics, treatment and outcomes for all emergency department patients fulfilling criteria for septic shock: a prospective observational study.” Eur J Emerg Med. 2018 Apr;25(2): 97-104. doi: 10.1097/MEJ.0000000000000419.
  8. Kuttab H, et al. Evaluation and Predictors of Fluid Resuscitation in Patients with Severe Sepsis and Septic Shock. Crit Care Med. 2019 Nov;47(11):1582-1590. doi: 10.1097/CCM.0000000000003960.