Background

The indication, composition and timing of administration of non-resuscitation fluid in septic shock have so far received little attention and accordingly the potential to reduce this source of fluid is unknown. The objective of the study was to quantify and characterize non-resuscitation fluid administered to patients with septic shock.

Methods

This prospective observational study was performed in eight intensive care units in Sweden and Canada during 4 months in 2018. Adult patients with septic shock within 24 h of admission to the intensive care unit were eligible for inclusion. Non-resuscitation fluids were defined as fluids other than colloids, blood products and crystalloids at a rate ≥ 5 ml/kg/h. Indication, volume and type of fluid were recorded during the first 5 days after admission. A maximum of 30 patients could be included per centre. To estimate the potential to reduce administration of non-resuscitation fluid, a pragmatic “restrictive” protocol for administration of non-resuscitation fluids was devised based on the most restrictive practice already in place for non-resuscitation fluids at any of the participating centres. Data are presented as median (interquartile range [IQR]).

Results

A total of 200 patients were included in the study and the 30-day mortality was 35%. Patients received a total of 7870 (4060–12,340) ml of non-resuscitation fluids and 2820 (1430–4580) of resuscitation fluids during the observation period. Median volumes of non-resuscitation and resuscitation fluids were similar at day 1 (1620 [710–2320] and 1590 [520–3000]) ml, respectively) and non-resuscitation fluids represented the largest source of fluid from day 2 and onwards after admission to the ICU. Vehicles for drugs such as vasoactive drugs and antibiotics constituted the largest fraction of non-resuscitation fluids (2400 [1270–4030] ml) during the 5-day observation period. Modelling suggested that volume of non-resuscitation fluids could be reduced by 2840 (1270–4900) ml during the first 5 days of admission to the ICU, mainly through reducing maintenance fluids.

Conclusions

Non-resuscitation fluids constitute the major fraction of fluids administered in the ICU to patients suffering from septic shock and may represent the largest modifiable target to reduce fluid overload.

中文翻译：

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败血性休克期间非复苏液体的调查：一项多中心前瞻性观察研究。

背景

迄今为止，在脓毒性休克中使用非复苏液体的适应症，组成和给药时间很少受到关注，因此减少这种液体来源的潜力尚不清楚。该研究的目的是量化和表征给予败血性休克患者的非复苏液。

方法

这项前瞻性观察性研究于2018年的4个月内在瑞典和加拿大的8个重症监护病房进行。成年病人在重症监护病房入院后24小时内患有败血性休克，符合入选条件。非复苏液体的定义是除胶体，血液制品和晶体以外的其他液体，其速度≥5 ml / kg / h。入院后的头5天内记录体液的指征，量和类型。每个中心最多可容纳30名患者。为了估计减少非复苏液给药的潜力，根据在任何参与中心针对非复苏液实施的最严格的实践，设计了一种实用的“限制性”方案，用于非复苏液的给药。

结果

该研究共纳入200名患者，其30天死亡率为35％。在观察期内，患者共接受了7870（4060–12,340）ml的非复苏液和2820（1430–4580）的复苏液。第1天的非复苏液和复苏液的中位数相似（分别为1620 [710–2320]和1590 [520–3000]）ml），从第2天及以后，非复苏液是最大的液体来源进入ICU。在5天的观察期内，用于血管活性药物和抗生素的药物媒介物是非复苏液体的最大部分（2400 [1270-4030] ml）。模型表明，在进入ICU的前5天，非复苏液体的体积可以减少2840（1270-4900）ml，

结论

非复苏液体是在ICU中向败血性休克患者施用的液体的主要部分，并且可能代表减少液体超负荷的最大可修改目标。