Adele Venable, PharmD
PGY2 Critical Care Pharmacy Resident
Saint Joseph Hospital Lexington
Lexington, Kentucky
Disclosure information not submitted.
Patrick Ratliff, PharmD, BCPS, BCCCP
Critical Care/EM Clinical Pharmacy Specialist; PGY2 Critical Care Residency Director
Saint Joseph Hospital, United States
Disclosure information not submitted.
Title: Assessing the Impact of Fluid Resuscitation Volumes in the Septic Geriatric Population
INTRODUCTION/HYPOTHESIS:
The Surviving Sepsis Campaign guidelines recommend an IV crystalloid fluid bolus of 30 mL/kg for septic patients with hypotension (MAP < 65 or SBP < 90 mmHg) and/or lactate ≥4 mmol/L. Recent literature has associated fluid restricted patients (advanced heart failure, end-stage chronic renal disease) that received the full 30 mL/kg bolus with an increased length of stay, leading Centers for Medicare and Medicaid services to exempt these patients from a full bolus requirement. The goal of this study is to describe outcomes associated with different fluid bolus volumes in geriatric patients.
Methods:
A retrospective analysis of patients at a 433-bed community hospital in Kentucky was conducted. Patients admitted from 10/2016 to 05/2021 for ≥24 hours receiving a fluid bolus within 3 hours for hypotension or elevated lactate were included. Data was collected using an institution-specific database and electronic health record. Patients were stratified with regard to age and mL/kg of fluid administered. Categorical data was analyzed with a Chi square or Fischer’s exact test, while continuous data was analyzed with a Mann-Whitney U test.
Results:
A total of 570 patients >60 years old met inclusion criteria. There were 124 patients in the < 27 mL/kg group (group A) and 446 patients in the ≥27 mL/kg group (group B). The majority of group A and group B were female (50.8% vs 56.1%; p=0.299), Caucasian (91.1% vs 87.8%; p=0.361), and classified as septic shock (64.5% vs 64.3%; p=0.973). The primary outcome, length of stay (LOS), was not statistically significant between the two groups (median 9.0 vs 8.0 days; p=0.334). Other outcomes that did not reach statistical significance include readmission (71.3% vs 73.3%; p=0.958) and mortality (4.0% vs 4.9%; p=0.676). In addition, no difference in LOS was found when comparing fluid volumes (< 27ml/kg vs ≥27 mL/kg) by stratified age groups (60-69 [5.5 vs 6.0 days; p=0.420], 70-79 [9.0 vs 9.0 days; p=0.467], and ≥ 80 [16.0 vs 16.0 days; p=0.793]).
Conclusions:
Utilizing less than the recommended fluid bolus for septic and septic shock geriatric patients had no significant impact on length of stay. According to this analysis age is likely the greatest predictor of length of stay in geriatric septic patients unless concomitant fluid restrictive conditions exist.