PURPOSE: Current guidelines for hemodynamic management of patients with severe sepsis and septic shock recommend use of early goal directed therapy (EGDT). Studies utilizing EGDT focus on first hours of treatment, and recommend aggressive fluid resuscitation. Questions remain regarding optimal fluid management beyond initial phases of resuscitation, especially the potential harms of fluid overload in patients with acute lung injury. We hypothesized that in patients treated with EGDT, positive fluid balance at 72 hours would correlate with increased length of mechanical ventilation.
METHODS: Project IMPACT database was utilized to identify patients with septic shock who received EGDT. Duration of mechanical ventilation, amount of fluid given during first 6 hours of arrival to hospital, total amount of fluid balance in first 72 hours, and mortality was recorded along with co-morbidities and APACHE II score. Data were analyzed using multiple regression analysis.
RESULTS: Of all the patients identified, 82 patients met the criteria for inclusion. Fluid balance at 72 hours had a linear correlation with duration of mechanical ventilation. However, this relationship was not statistically significant after adjusting for APACHE II score. Similarly, positive fluid balance at 72 hours had a linear correlation with mortality that was not statistically significant after adjusting for APACHE II score.
CONCLUSION: In our study positive fluid balance at 72 hours in patients with severe sepsis and septic shock treated with EGDT had a linear association with poor outcome. However, when adjusted for APACHE II score there was no statistical significance. A larger study is needed to further evaluate our hypothesis.
CLINICAL IMPLICATIONS: Positive fluid balance at 72 hours in patients with severe sepsis and septic shock treated with EGDT has a trend toward poor outcomes.
DISCLOSURE: Ankur Kalra, No Financial Disclosure Information; No Product/Research Disclosure Information