Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial.

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Abstract

We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock.

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Most cited references 8

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Fluid challenges in intensive care: the FENICE study

Maurizio Cecconi, Christoph Hofer, Jean-Louis Teboul … (2015)

Background Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. Methods This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC. Results 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500–1000). The median time was 24 min (40–60 min), and the median rate of FC was 1000 [500–1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57–61 %). In 43 % (CI 41–45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34–37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20–24 %). No safety variable for the FC was used in 72 % (CI 70–74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response. Conclusions The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account. Electronic supplementary material The online version of this article (doi:10.1007/s00134-015-3850-x) contains supplementary material, which is available to authorized users.

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Resuscitation Fluids

John A Myburgh, Michael G Mythen (2013)

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Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study

Suvi Vaara, Anna-Maija Korhonen, Kirsi-Maija Kaukonen … (2012)

Introduction Positive fluid balance has been associated with an increased risk for mortality in critically ill patients with acute kidney injury with or without renal replacement therapy (RRT). Data on fluid accumulation prior to RRT initiation and mortality are limited. We aimed to study the association between fluid accumulation at RRT initiation and 90-day mortality. Methods We conducted a prospective, multicenter, observational cohort study in 17 Finnish intensive care units (ICUs) during a five-month period. We collected data on patient characteristics, RRT timing, and parameters at RRT initiation. We studied the association of parameters at RRT initiation, including fluid overload (defined as cumulative fluid accumulation > 10% of baseline weight) with 90-day mortality. Results We included 296 RRT-treated critically ill patients. Of 283 patients with complete data on fluid balance, 76 (26.9%) patients had fluid overload. The median (interquartile range) time from ICU admission to RRT initiation was 14 (3.3 to 41.5) hours. The 90-day mortality rate of the whole cohort was 116 of 296 (39.2%; 95% confidence interval 38.6 to 39.8%). The crude 90-day mortality of patients with or without fluid overload was 45 of 76 (59.2%) vs. 65 of 207 (31.4%), P < 0.001. In logistic regression, fluid overload was associated with an increased risk for 90-day mortality (odds ratio 2.6) after adjusting for disease severity, time of RRT initiation, initial RRT modality, and sepsis. Of the 168 survivors with data on RRT use at 90 days, 34 (18.9%, 95% CI 13.2 to 24.6%) were still dependent on RRT. Conclusions Patients with fluid overload at RRT initiation had twice as high crude 90-day mortality compared to those without. Fluid overload was associated with increased risk for 90-day mortality even after adjustments.

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Journal

Journal ID (iso-abbrev): Intensive Care Med

Title: Intensive care medicine

Publisher: Springer Nature

ISSN (Electronic): 1432-1238

ISSN (Print): 0342-4642

Publication date (Electronic): Nov 2016

Volume: 42

Issue: 11

Affiliations

[1 ] Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

[2 ] Department of Intensive Care, Randers Hospital, Randers, Denmark.

[3 ] Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark.

[4 ] Department of Intensive Care, Herning Hospital, Herning, Denmark.

[5 ] Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland.

[6 ] Department of Intensive Care, Holbæk Hospital, Holbæk, Denmark.

[7 ] Department of Intensive Care, Holstebro Hospital, Holstebro, Denmark.

[8 ] Department of Intensive Care, Nordsjællands Hospital, Hillerød, Denmark.

[9 ] Department of Intensive Care, Herlev Hospital, Herlev Municipality, Denmark.

[10 ] Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

[11 ] Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. anders.perner@regionh.dk.

[12 ] Centre for Research in Intensive Care, Copenhagen, Denmark. anders.perner@regionh.dk.

Article

Publisher Item ID: 10.1007/s00134-016-4500-7

DOI: 10.1007/s00134-016-4500-7

PubMed ID: 27686349

SO-VID: 8df6313d-79cc-47ce-b2f4-b0d5754fe412

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Keywords: Critical care,Fluid therapy,Intensive care,Resuscitation,Sepsis,Septic,Shock

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Keywords: Critical care, Fluid therapy, Intensive care, Resuscitation, Sepsis, Septic, Shock

Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial.

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Most cited references 8

Fluid challenges in intensive care: the FENICE study

Resuscitation Fluids

Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study

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