Miranda Boraas
North Florida/South Georgia Veterans Health System
Gainesville, Florida
Disclosure information not submitted.
Robert Ross, PharmD
Clinical Pharmacy Research Fellow
NF/SG VA Health System
Gainesville, Florida
Disclosure information not submitted.
Abbie Rosen, PharmD
Clinical Pharmacy Specialist
North Florida/South Georgia Veterans Health System
Gainesville, Florida, United States
Disclosure information not submitted.
Andrew Franck, PharmD
Clinical Pharmacy Specialist
North Florida/South Georgia Veterans Health System, United States
Disclosure information not submitted.
Title: Fluid Administration in Septic Shock
Introductin/Hypothesis: Septic shock is a subset of sepsis characterized by hypotension after fluid resuscitation requiring vasopressor medications. Guidelines recommend an initial fluid resuscitation dose of 30 ml/kg intravenous (IV) crystalloid fluid for septic patients within the first 3 hours of presentation. While there is a consensus on the need for early fluid administration in septic shock, the optimal dose remains uncertain. This study aimed to compare outcomes for patients who received guideline recommended fluid doses to those who did not.
Methods: This study included patients admitted to a single Veterans Affairs (VA) health-system who were treated for septic shock from January 1, 2010 to December 31, 2020. Groups of patients receiving IV fluid doses of less than 30 ml/kg and at least 30 ml/kg within 3 hours of presentation were compared for the outcomes of mortality, vasopressor requirements, corticosteroid administration, diuretic administration, length of stay and development of acute kidney injury (AKI).
Results: A total of 850 patients were included; 734 in the < 30 ml/kg group and 116 in the ≥ 30 ml/kg group. Heart failure and body mass index were significantly greater in the < 30 ml/kg group, but all other baseline characteristics were similar. In the < 30 ml/kg group, 71.1% developed AKI versus 51.7% in the ≥ 30 ml/kg group (p< 0.01). The proportion of patients requiring multiple vasopressors was numerically greater in the < 30 ml/kg group compared to the ≥ 30 ml/kg group (43.6% vs. 52.6%, p=0.09). There was no significant difference in mortality between groups (90-day: 11.9% vs. 9.6%, p=0.82; 30-day: 21.1% vs. 24.6%, p=0.62; in-hospital: 45.1% vs. 40.5%, p=0.41). No significant differences were seen in the other evaluated outcomes.
Conclusions: In this evaluation of IV fluid doses for patients with septic shock, significant differences were not observed for most outcomes between patients who received guideline recommended fluid resuscitation compared to those who did not. However, the significantly higher AKI in patients who received less then guideline recommended IV fluid doses is notable. This study provides support for guideline recommendations and may serve as hypothesis generation for further study of fluid administration in septic shock.