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Critical Care |

NICOM Directed Fluid Resuscitation in Severe Sepsis and Septic Shock Reduces Fluid Balance

Charles Bengtson, MD; Steven Simpson, MD; Heath Latham, MD
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University of Kansas Medical Center, Overland Park, KS


Chest. 2015;148(4_MeetingAbstracts):343A. doi:10.1378/chest.2273716
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Abstract

SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Fluid resuscitation is integral to severe sepsis and septic shock treatment, although the optimal volume is difficult to determine, and an increasing body of literature suggests that decreased fluid balance is associated with reduced mortality. We studied non-invasive cardiac output monitoring (NICOM), a validated hemodynamic monitoring device, in severe sepsis and septic shock patients to determine whether stroke volume directed fluid administration could alter the volume of fluid administered and/or sepsis outcomes.

METHODS: We conducted a retrospective chart review and cohort analysis of patients in our MICU with a diagnosis of severe sepsis or septic shock between April 1, 2014 and October 1, 2014, whose volume therapy was directed by NICOM, compared with matched controls who received usual care. The primary outcome of interest was fluid balance during ICU stay. Secondary outcomes included mortality, ICU length of stay and need for hemodialysis. Unpaired t-test was used to compare the groups regarding the primary outcome and Fisher’s exact test was used to compare mortality.

RESULTS: Forty-six patients (NICOM = 31, control = 15), were identified. The mean SAPS II score was 50 in both groups. The primary outcome of decreased fluid balance was met with a total fluid balance of 3.6L for the NICOM group and 6.6L for the control group (CI for difference in administered volume 550-5500, p=0.02). There was no difference in hospital mortality (RR 0.98, CI 0.67-1.42, p=1.0) or ICU length of stay when adjusted for outliers (CI -2.5-2.5, p=0.96). There was a trend toward a decrease in dialysis in the NICOM group that did not meet statistical significance (RR 0.48, p=0.37).

CONCLUSIONS: In this small study we demonstrated that using NICOM to direct fluid resuscitation showed a clinically and statistically significant decrease in fluid balance, a risk factor for mortality, in severe sepsis and septic shock. In addition, our data shows a trend toward a decrease in interventions such as hemodialysis. Further prospective studies will be useful to elucidate these associations.

CLINICAL IMPLICATIONS: To date, several studies have shown non-invasive means of hemodynamic monitoring to be valid to direct fluid resuscitation, but we believe this is the first study to associate it with improved outcomes.

DISCLOSURE: The following authors have nothing to disclose: Charles Bengtson, Steven Simpson, Heath Latham

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