Critical Care: Sepsis Diagnosis and Resuscitation |

Fluid Resuscitation and Clinical Outcomes in Patients With Known Heart Failure Who Develop Severe Sepsis or Septic Shock FREE TO VIEW

Wing Sun Tam, MBChB; Jeffrey Fried, MD; Jonathan Grotts, MA; Tyler Paras, BS
Author and Funding Information

Santa Barbara Cottage Hospital, Santa Barbara, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):350A. doi:10.1016/j.chest.2016.08.363
Text Size: A A A
Published online

SESSION TITLE: Sepsis Diagnosis and Resuscitation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 11:00 AM - 12:15 PM

PURPOSE: It is unclear if patients with known heart failure (HF) who develop severe sepsis (SS) or septic shock (SShock) receive adequate fluid resuscitation due to the concern that aggressive fluid resuscitation might increase the risk of fluid overload and adverse events. This study compared the amount of fluid received by patients with known HF and those without known HF, and the development of adverse events including intubation, CPAP/BIPAP use, cardiovascular (CV) complications, acute kidney injury (AKI), hospital length of stay (LOS), ICU LOS and mortality in these two groups

METHODS: All patients admitted from our ED to our adult twenty-bed MICU and twenty-bed SICU with SS or SShock between 07/01/2013 and 12/31/2014 were prospectively identified by our IRB approved Santa Barbara Cottage Hospital Sepsis Registry. The registry includes demographic and clinical data, including APACHE II scores. We retrospectively classified patients as having known HF based on prior clinical history documentation and echocardiogram reports. We excluded patients who presented with concurrent acute decompensated HF. Fluid volumes (adjusted for actual body weight), net fluid balance, LOS and APACHE II scores are reported as medians. All other values are reported as means.

RESULTS: Among the 272 patients in this study, 36 had known HF and 236 did not. Patients with known HF were more likely to be older (67.8 vs 56.5, p=0.001), male (69.4% vs 49.2%, p=0.031) and have a history of coronary artery disease (27.8% vs 6.8%, p=0.001), hypertension (69.4% vs 37.3%, p<0.001) and ESRD (16.7% vs 4.7%, p=0.015). APACHE II scores were similar in patients with known HF versus no known HF (16 vs 17, p=0.151). Patients with known HF received less fluid compared to patients without known HF at hour 6 (41.2 vs 55.9ml/kg, p=0.018), hour 12 (54 vs 75.6 ml/kg, p=0.001), hour 24 (67.1 vs 102.2ml/kg, p<0.001) and hour 48 (90.1 vs 131.1ml/kg, p=<001). There was no significant difference between patients with known HF and patients without known HF in net fluid balance at hour 6 (39.3 vs 48.1ml/kg, p=0.068) and hour 48 (49.6 vs 69.3 ml/kg, p=0.069), hospital LOS (5.4 vs 4.8 days, p=0.814), ICU LOS (2.2 vs 1.9 days, p=0.799), and the rates of persistent hypotension at hour 48 (16.7% vs 17.9%, p=1), intubation (3% vs 10.1%, p=0.327), CPAP/BIPAP use (0% vs 5.6%, p=0.374), CV complications (11.1% vs 6.8%, p=0.316), AKI (40% vs 37.6%, p=0.852) and mortality (11.1% vs 8.1%, p=0.522).

CONCLUSIONS: Though receiving less fluid than patients without known HF, patients with known HF received over 40ml/kg of fluids within the first 6 hours of sepsis onset. The incidence of adverse clinical events such as intubation rate, CPAP/BIPAP use, CV complications, AKI, hospital LOS, ICU LOS and mortality were not increased in patients with known HF and SS or SShock.

CLINICAL IMPLICATIONS: It appears to be safe to give patients with SS or SShock and a known history of HF at least the recommended 30ml/kg of fluid resuscitation within the first six hours of sepsis onset.

DISCLOSURE: The following authors have nothing to disclose: Wing Sun Tam, Jeffrey Fried, Jonathan Grotts, Tyler Paras

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543