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Original Research: CRITICAL CARE MEDICINE |

The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock

Claire V. Murphy, PharmD; Garrett E. Schramm, PharmD; Joshua A. Doherty, BS; Richard M. Reichley, RPh; Ognjen Gajic, MD, FCCP; Bekele Afessa, MD, FCCP; Scott T. Micek, PharmD; Marin H. Kollef, MD, FCCP
Author and Funding Information

From the Department of Pharmacy (Drs. Murphy and Micek), Barnes-Jewish Hospital, St. Louis, MO; Hospital Pharmacy Services (Dr. Schramm), and the Division of Pulmonary and Critical Care Medicine (Drs. Gajic and Afessa), Mayo Clinic, Rochester, MN; Medical Informatics (Mr. Doherty and Mr. Reichley), BJC Healthcare, St. Louis, MO; and the Division of Pulmonary and Critical Care Medicine (Dr. Kollef), Washington University School of Medicine, St. Louis, MO.

Correspondence to: Marin H. Kollef, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef@im.wustl.edu


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):102-109. doi:10.1378/chest.08-2706
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Background:  Recent studies have suggested that early goal-directed resuscitation of patients with septic shock and conservative fluid management of patients with acute lung injury (ALI) can improve outcomes. Because these may be seen as potentially conflicting practices, we set out to determine the influence of fluid management on the outcomes of patients with septic shock complicated by ALI.

Methods:  A retrospective analysis was performed at Barnes-Jewish Hospital (St. Louis, MO) and in the medical ICU of Mayo Medical Center (Rochester, MN). Patients hospitalized with septic shock were enrolled into the study if they met the American-European Consensus definition of ALI within 72 h of septic shock onset. Adequate initial fluid resuscitation (AIFR) was defined as the administration of an initial fluid bolus of ≥ 20 mL/kg prior to and achievement of a central venous pressure of ≥ 8 mm Hg within 6 h after the onset of therapy with vasopressors. Conservative late fluid management (CLFM) was defined as even-to-negative fluid balance measured on at least 2 consecutive days during the first 7 days after septic shock onset.

Results:  The study cohort was made up of 212 patients with ALI complicating septic shock. Hospital mortality was statistically lowest for those achieving both AIFR and CLFM and higher for those achieving only CLFM, those achieving only AIFR, and those achieving neither (17 of 93 patients [18.3%] vs 13 of 31 patients [41.9%] vs 30 of 53 patients [56.6%] vs 27 of 35 [77.1%], respectively; p < 0.001).

Conclusions:  Both early and late fluid management of septic shock complicated by ALI can influence patient outcomes.

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