Aaron Chase
PGY-2 Critical Care Pharmacy Resident
Augusta University Medical Center
Augusta, Georgia
Disclosure information not submitted.
Susan Smith, BCCCP, BCPS, PharmD
Clinical Associate Professor
University of Georgia
Athens, Georgia
Disclosure information not submitted.
Andre Holder, MD, MS
Assistant Professor
Grady Memorial Hospital
Atlanta, Georgia
Disclosure information not submitted.
Andrea Sikora, BCCCP, PharmD
Critial Care Pharmacy Specialist
University of Georgia College of Pharmacy
Augusta, Georgia
Disclosure information not submitted.
Title: Characterizing fluid and vasopressor use in reduced ejection fraction: reanalysis of VOLUME-CHASERS
Introduction: Fluids and vasopressors are core to sepsis management, but guidelines provide no recommendations for patients with low ejection fraction (EF). Evidence suggests that all septic patients should receive 30 mL/kg of crystalloids for fluid resuscitation, regardless of EF. Despite this, observational studies demonstrate variation in resuscitation strategies in patients with and without reduced EF. The purpose of this study was to identify differences in fluid and vasopressor management strategies between patients with reduced and preserved EF.
Methods: Fluids and vasopressors are core to sepsis management, but guidelines provide no recommendations for patients with low ejection fraction (EF). Evidence suggests that all septic patients should receive 30 mL/kg of crystalloids for fluid resuscitation, regardless of EF. Despite this, studies demonstrate variation in resuscitation strategies in patients with and without reduced EF. The purpose of this study was to identify differences in fluid and vasopressor management strategies between patients with reduced and preserved EF.
Results: This study included 110 patients, 52 (47.3%) and 58 (52.7%) with reduced and preserved EF, respectively. The average age was 69 (SD: 12.7) years, and baseline variables (SOFA, age, and sex) were similar between groups, with the exception of EF (28% vs 43%, p< 0.001). Mortality (30.7% vs 32.8%) and ICU LOS (10.9 vs 12.1 days) were similar between groups. No differences in type, dose, or proportion of patients on vasopressor at any time were identified. Mean crystalloid volume administered in the first 24 hours were similar between groups (p >0.05). Volume administered on days 2-7 was similar. Interestingly, patients with reduced EF had a higher urine output at time points 12-24, 0-24, 24-48, and 72-96 hours (p< 0.05), potentially suggesting a difference in management of fluid removal strategy.
Conclusions: Upon reanalysis of VOLUME-CHASERS data, we did not identify a significant difference in patient outcome, fluid or vasopressor dosing, or timing based on the presence of reduced EF. Though retrospective analysis precludes definitive conclusions, these results are notable in that they add further support that initial resuscitation strategies apply to all septic patients regardless of cardiac function.