Home
|
Inbox
|
Search
|
View Abstract
Association of Fluid Balance at 72 Hours and Mortality in Septic Patients
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A3268 - Association of Fluid Balance at 72 Hours and Mortality in Septic Patients
Author Block: S. M. Eikermann1, G. Balakrishnan2, J. Chandler3, G. H. Howell4; 1Graduate Medical Education, UMKC, Kansas City, MO, United States, 2Pulmonary and critical care, UMKC, Kansas City, MO, United States, 3KCUMB, Kansas City, MO, United States, 4Midwest Pulm Consultants, Kansas City, MO, United States.
Rationale One of the cornerstones of early-goal-directed therapy (EGDT) in the management of patients with sepsis and septic shock is fluid resuscitation. While it is well known that EGDT with aggressive fluid resuscitation improves survival in sepsis, literature has shown that septic patients treated with EGDT are at risk of becoming volume overloaded (Kelm, et. al). Volume overload in patients with sepsis and septic shock is associated with increased mortality. The goal of our quality improvement project was to evaluate the correlation of positive fluid balance at 72 hours with mortality in septic patients admitted to the Intensive Care Unit (ICU).
Methods Institutional Review Board (IRB) approval was obtained to retrospectively evaluate a dataset of patients admitted within 24 hours to the ICU with the ICD-10 diagnosis codes of sepsis and septic shock in five hospitals around Kansas City, Missouri from May 1st, 2017 to June 31st, 2017. Patients were excluded if not admitted to the ICU within 24 hours or if they lacked the necessary diagnosis codes or intake and output records. 115 adult patients meeting inclusion criteria were selected and data was obtained via EPIC Clarity Dataset. The patients’ net fluid balance at 72 hours was given a grade between 0-5; 0 for negative, 1 for 1ml-5,000ml positive, 2 for 5,001ml-10,000ml, 3 for 10,001ml-15,000ml, 4 for 15,001ml-20,000ml, and 5 for >20,000ml.
Results Of 115 subjects meeting inclusion criteria, 34 were deceased and 81 were living at 90 days. Using logistic regression, it was shown that for every one grade increase in net fluid balance, the risk of death increased by 71% (95% C.I. 1.12-2.61). This correlation was found to be statistically significant with a P-Value = 0.013.
Conclusions This study shows that a positive fluid balance at 72 hours in ICU patients with sepsis and septic shock was associated with increased mortality. Additionally, the risk of death increased with the severity of the grade of positive net fluid balance. Whether the increased fluid balance was a contributor to mortality or marker of severity of illness requires further study.
Kelm, D.J., et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock. 2015;43:68-73.
Author Block: S. M. Eikermann1, G. Balakrishnan2, J. Chandler3, G. H. Howell4; 1Graduate Medical Education, UMKC, Kansas City, MO, United States, 2Pulmonary and critical care, UMKC, Kansas City, MO, United States, 3KCUMB, Kansas City, MO, United States, 4Midwest Pulm Consultants, Kansas City, MO, United States.
Rationale One of the cornerstones of early-goal-directed therapy (EGDT) in the management of patients with sepsis and septic shock is fluid resuscitation. While it is well known that EGDT with aggressive fluid resuscitation improves survival in sepsis, literature has shown that septic patients treated with EGDT are at risk of becoming volume overloaded (Kelm, et. al). Volume overload in patients with sepsis and septic shock is associated with increased mortality. The goal of our quality improvement project was to evaluate the correlation of positive fluid balance at 72 hours with mortality in septic patients admitted to the Intensive Care Unit (ICU).
Methods Institutional Review Board (IRB) approval was obtained to retrospectively evaluate a dataset of patients admitted within 24 hours to the ICU with the ICD-10 diagnosis codes of sepsis and septic shock in five hospitals around Kansas City, Missouri from May 1st, 2017 to June 31st, 2017. Patients were excluded if not admitted to the ICU within 24 hours or if they lacked the necessary diagnosis codes or intake and output records. 115 adult patients meeting inclusion criteria were selected and data was obtained via EPIC Clarity Dataset. The patients’ net fluid balance at 72 hours was given a grade between 0-5; 0 for negative, 1 for 1ml-5,000ml positive, 2 for 5,001ml-10,000ml, 3 for 10,001ml-15,000ml, 4 for 15,001ml-20,000ml, and 5 for >20,000ml.
Results Of 115 subjects meeting inclusion criteria, 34 were deceased and 81 were living at 90 days. Using logistic regression, it was shown that for every one grade increase in net fluid balance, the risk of death increased by 71% (95% C.I. 1.12-2.61). This correlation was found to be statistically significant with a P-Value = 0.013.
Conclusions This study shows that a positive fluid balance at 72 hours in ICU patients with sepsis and septic shock was associated with increased mortality. Additionally, the risk of death increased with the severity of the grade of positive net fluid balance. Whether the increased fluid balance was a contributor to mortality or marker of severity of illness requires further study.
Kelm, D.J., et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock. 2015;43:68-73.
|
Home
|
Inbox
|
Search
|