Association Between Volume of Fluid Resuscitation and Intubation in High-Risk Patients With Sepsis, Heart Failure, End-Stage Renal Disease, and Cirrhosis

Chest. 2020 Feb;157(2):286-292. doi: 10.1016/j.chest.2019.09.029. Epub 2019 Oct 14.

Abstract

Background: Initial fluid resuscitation volume for sepsis is controversial, particularly in patients at high baseline risk for complications. This study was designed to assess the association between 30 mL/kg crystalloids and intubation in patients with sepsis or septic shock and heart failure, end-stage renal disease, or cirrhosis.

Methods: This propensity score-matched retrospective cohort study included patients with sepsis or septic shock admitted to a large medical ICU. Primary exposure was IV fluid volume in the first 6 h following sepsis diagnosis, divided into two cohorts: ≥ 30 mL/kg (standard group) and < 30 mL/kg (restricted group). The primary outcome was need for mechanical ventilation within 72 h following initiation of fluid resuscitation. Secondary outcomes were length of stay, ventilator days, and time to intubation.

Results: A total of 208 patients were included, with 104 (50%) in the restricted group (< 30 mL/kg) and 104 in the standard group (≥ 30 mL/kg). No difference in intubation incidence was detected between the two groups, with 36 patients (35%) in the restricted group and 33 (32%) in the standard group (adjusted OR, 0.75; 95% CI, 0.41-1.36; P = .34) intubated. There was no difference between standard and restricted groups in alive ICU-free days (17 ± 11 days vs 17 ± 10 days; P = .64), duration of mechanical ventilation (10 ± 12 days vs 11 ± 16 days; P = .96), or hours to intubation (16 ± 19 h vs 14 ± 15; P = .55).

Conclusions: No differences were detected in the incidence of intubation in patients with sepsis and cirrhosis, end-stage renal disease, or heart failure who received guideline-recommended fluid resuscitation with 30 mL/kg compared with patients initially resuscitated with a lower fluid volume.

Keywords: cirrhosis; heart failure; mechanical ventilation; renal failure; septic shock.

MeSH terms

  • Aged
  • Cohort Studies
  • Comorbidity
  • Crystalloid Solutions / administration & dosage*
  • Female
  • Fluid Therapy / methods*
  • Heart Failure / epidemiology*
  • Humans
  • Intensive Care Units
  • Intubation, Intratracheal / statistics & numerical data*
  • Kidney Failure, Chronic / epidemiology*
  • Length of Stay
  • Liver Cirrhosis / epidemiology*
  • Male
  • Middle Aged
  • Odds Ratio
  • Practice Guidelines as Topic
  • Propensity Score
  • Respiration, Artificial
  • Resuscitation
  • Retrospective Studies
  • Sepsis / epidemiology
  • Sepsis / therapy
  • Shock, Septic / epidemiology
  • Shock, Septic / therapy*
  • Time Factors

Substances

  • Crystalloid Solutions