PURPOSE: We sought to determine whether LV systolic dysfunction might inhibit physicians from administering protocolized fluid resuscitation in septic shock (SS) patients.
METHODS: Medical ICU (MICU) patients were reviewed prospectively for a 12 month period for the presence of severe sepsis. A sepsis-EGDT protocol was available with specific recommendations for volume of administration and hemodynamic endpoints. Patients with echocardiograms within the 1st 24 hrs of admission were analyzed for fluid resuscitation volumes in the 1st 6 hrs. Patients with echocardiograms were separated into abnormal (Ejection fraction <45%; without severe valvular heart disease) and normal LV systolic function, excluding poor quality studies. Volume of resuscitation, ventilator days, MICU days and mortality were compared by t-test using log transformed data when appropriate, (p<0.05).
RESULTS: 398 severe sepsis patients were reviewed; 169 had echocardiograms in the 1st 24 hrs of MICU admission. 42/169 were in SS with appropriate echocardiograms. The resuscitation volume within the first 6 hours for the LV systolic dysfunction (n=23) group was 1302 cc's/hr and 1002 cc's/hr for the normal LV function (n=19) group, respectively (p = .0975). No significant difference existed between the groups in terms of ventilator days (11.6 vs 9.3, p = .3724), MICU days (6.4 vs 11.2, p = 0.138), or mortality (36% vs. 44%, chi square, p= .759).
CONCLUSION: LV systolic dysfunction was not associated with reduced volume of resuscitation in SS patients compared to normal LV function SS patients. Additionally, with a sepsis-EGDT protocol in place, there were no statistically significant differences between groups in regards to ventilator days, MICU days or mortality.
CLINICAL IMPLICATIONS: LV Systolic dysfunction SS patients were managed with similar fluid resuscitation volumes as normal LV function SS patients and demonstrated similar hospital outcomes in this pilot study, which appears to support the notion that fluid administration to SS patients with LV systolic dysfunction can be guided by EGDT guidelines without untoward outcomes. Further studies may use novel echocardiographic techniques to guide volume of resuscitation.
DISCLOSURE: Robert Updaw, No Financial Disclosure Information; No Product/Research Disclosure Information