Observational studyCritical care (London, England)2012
Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort.
Observational study in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Pooled it
- Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis.Critical care (London, England) · 2019Pooled it
- Liberal Versus Restrictive Intravenous Fluid Therapy for Early Septic Shock: Rationale for a Randomized Trial.Annals of emergency medicine · 2018Pooled it
- Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis.Intensive care medicine · 2017Pooled it
- Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis.Critical care (London, England) · 2020Trial
- Trial
- The Indian Society of Critical Care Medicine Position Statement on the Management of Sepsis in Resource-limited Settings.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review.World journal of critical care medicine · 2023Review
- New Insights into the Fluid Management in Patients with Septic Shock.Medicina (Kaunas, Lithuania) · 2023Review
- Effect of fluid overload on survival in patients with sepsis-induced acute kidney injury receiving continuous renal replacement therapy.Scientific reports · 2023Article
- Early Albumin Infusion Is Associated With Greater Survival to Discharge Among Patients With Sepsis/Septic Shock Who Develop Severe Acute Kidney Injury Among Patients With Sepsis/Septic Shock Who Develop Severe Acute Kidney Injury.Critical care explorations · 2022Article
- Association between fluid balance and mortality for heart failure and sepsis: a propensity score-matching analysis.BMC anesthesiology · 2022Article
- Establishment and Implementation of Potential Fluid Therapy Balance Strategies for ICU Sepsis Patients Based on Reinforcement Learning.Frontiers in medicine · 2022Article
- Influence of fluid balance on the prognosis of patients with sepsis.BMC anesthesiology · 2021Article
- Should we start vasopressors very early in septic shock?Journal of thoracic disease · 2020Article
- Fluid resuscitation in sepsis: the great 30 mL per kg hoax.Journal of thoracic disease · 2020Review
- Hemoadsorption with CytoSorb shows a decreased observed versus expected 28-day all-cause mortality in ICU patients with septic shock: a propensity-score-weighted retrospective study.Critical care (London, England) · 2019Article
- Septic shock in the ER: diagnostic and management challenges.Open access emergency medicine : OAEM · 2019Article
- Time-related association between fluid balance and mortality in sepsis patients: interaction between fluid balance and haemodynamics.Scientific reports · 2018Article
- Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients.BMC pediatrics · 2018Article
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2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPatients with septic shock require fluid, but the optimum amount is unknown. Therefore we assessed patient characteristics and outcome associated with fluid volume in unselected patients with septic shock including those with three days of shock.
methodsWe conducted a prospective, multicenter, observational study of all adult patients with septic shock during a 3-month study period at six general ICUs: three in university hospitals and three in regional hospitals. After day 1 and 3 of shock, patients were divided into two groups according to the overall median fluid volumes. Characteristics between these groups were compared using non-parametric and Chi-square statistics.
resultsThe 164 included patients received median 4.0 l (IQR 2.3-6.3) of fluid during the first day of septic shock. Patients receiving higher volumes (> 4.0 l) on day 1 had higher p-lactate (3.4 (2.2-5.5) vs. 2.0 (1.6-3.0) mmol l(-1), P < 0.0001) compared to those receiving lower volumes. In contrast simplified acute physiology score (SAPS) II (54 (45-64) vs. 54 (45-67), P = 0.73), sequential organ failure assessment (SOFA) score (11 (9-13) vs. 11 (9-13), P = 0.78) and 90-day mortality (48 vs. 53%, P = 0.27) did not differ between groups. The 95 patients who still had shock on day 3 had received 7.5 l (4.3 - 10.8) of fluid by the end of day 3. Patients receiving higher volumes (> 7.5 l) had higher p-lactate (2.6 (1.7-3.4) vs. 1.9 (1.6-2.4) mmol l(-1), P < 0.01) on day 3 and lower 90-day mortality (40 vs. 62%, P = 0.03) than those receiving lower volumes in spite of comparable admission SAPS II (53 (46-67) vs. 55 (49-62), P = 0.47) and SOFA scores on day 3 (10 (8-13) vs. 11 (10-14), P = 0.33).
conclusionsIn this cohort of unselected ICU patients with septic shock, initial fluid volume was not associated with mortality. In patients with shock for three days or more, higher fluid volumes including crystalloids, colloids and blood products were associated with reduced mortality.
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