PURPOSE:Acute lung injury (ALI) secondary to septic shock (SS) is associated with a significantly higher mortality rate than other etiologies of ALI. This retrospective study aims to identify predictors of mortality in patients with SS and ALI.
METHODS:A cohort analysis of patients with ALI secondary to SS was performed comparing clinical characteristics of survivors [(S), n = 50] and non-survivors [(NS), n = 35]. Independent predictors of mortality were identified using logistic regression analysis.
RESULTS:85 patients from January 1, 2005 –December 31, 2006 were evaluated with an in-hospital mortality rate of 41.2%. Baseline characteristics including APACHE II score, PaO2:FiO2 ratio, and disease co-morbidities were similar between S and NS. The onset of SS/ALI occurred more commonly in healthcare setting in NS compared to in S (49% v. 22%, p=0.034). Survivors received a significantly larger mean fluid resuscitation volume within 12 hours of onset of SS (3557 ml v. 2384 ml, p=0.035). Survivors were also more likely to have central venous pressure (CVP) monitoring and achieve CVP > 8mmHg within 12 hours of onset of SS (S 94% vs. NS 77%, p=0.023 and S 82% vs. 51%, p=0.003 respectively). Survivors had a significantly lower mean ICU (+9.8 L v. +19.5 L, p =0.002) and hospital fluid balances (+5.3 L v. +23.4 L, p<0.001).Location in a healthcare facility during the onset of septic shock [AOR(95%CI) 12.2 (2.1–72.2), p=0.006] and excessive hospital fluid balance in 1 liter increments [1.06 (1.01–1.12), p=0.03) were independent predictors of hospital mortality. Achievement of CVP >8mmHg within 12 hours of septic shock onset [0.11 (0.02–0.49), p=0.004] and adequate early fluid resuscitation in 1 liter increments [0.68 (0.49–0.95), p=0.022) were independent predictors of hospital survival.
CONCLUSION:Despite advances in our understanding of fluid management in ALI, it remains complex in patients with ALI associated with SS. This analysis identified an association between early goal directed fluid resuscitation, avoidance of excessive fluid balance and survival.
CLINICAL IMPLICATIONS:Fluid management in ALI secondary to SS warrants further investigation.
DISCLOSURE:Claire Murphy, No Financial Disclosure Information; No Product/Research Disclosure Information