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Original Research: Critical Care |

Increased Fluid Administration in the First Three Hours of Sepsis Resuscitation Is Associated With Reduced MortalityIncreased Fluids in First Three Hours of Sepsis: A Retrospective Cohort Study

Sarah J. Lee, MD, MPH; Kannan Ramar, MBBS, MD; John G. Park, MD, FCCP; Ognjen Gajic, MD, FCCP; Guangxi Li, MD; Rahul Kashyap, MBBS
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

CORRESPONDENCE TO: Rahul Kashyap, MBBS, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: Kashyap.Rahul@mayo.edu


Part of this article has been presented in abstract form at the 42nd Critical Care Congress, January 19-23, 2013, San Juan, Puerto Rico.

FUNDING/SUPPORT: This publication was supported by the National Center for Advancing Translational Sciences [Grant UL1 TR000135].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):908-915. doi:10.1378/chest.13-2702
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BACKGROUND:  The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time.

METHODS:  This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009. Data were collected from a previously validated electronic medical database. Multivariate regression modeling was performed, adjusting for age, admission weight, Sequential Organ Failure Assessment score, APACHE (Acute Physiology and Chronic Health Examination) III score, and total fluid administration within the first 6 h of sepsis onset time.

RESULTS:  Of 651 patients with severe sepsis and septic shock screened, 594 had detailed fluid data. In a univariate analysis, the median amount of fluid within the first 3 h for survivors at discharge was 2,085 mL (940-4,080 mL) and for nonsurvivors, 1,600 mL (600-3,010 mL; P = .007). In comparison, during the latter 3 h, the median amount was 660 mL (290-1,485 mL) vs 800 mL (360-1,680 mL; P = .09), respectively. After adjusting for confounders, the higher proportion of total fluid received within the first 3 h was associated with decreased hospital mortality (OR, 0.34; 95% CI, 0.15-0.75; P = .008).

CONCLUSIONS:  Earlier fluid resuscitation (within the first 3 h) is associated with a greater number of survivors with severe sepsis and septic shock.

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