Outcomes for Patients with Congestive Heart Failure and Chronic Kidney Disease Receiving Fluid Resuscitation for Severe Sepsis or Septic Shock
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Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock.
We performed a retrospective case-control study of Emergency Department patients treated for severe sepsis or septic shock. We identified subjects with a history of CHF or CKD (at-risk group [AR]) and a sample of patients without a history of CHF/ CKD (control group). We performed a structured chart review recording demographics, fluids received, airway interventions required, and outcome. Logistic regression analysis was used to compare the association between the amount of IV fluids received and the outcomes of interest.
Our cohort consisted of 745 patients with a history of CHF and/or CKD (AR group) and 570 patients without a history of CHF and/or CKD (control group). Overall patients in the AR group received less IVFs than the control group at 24 hours. There was a significant association between receipt of >30cc/kg of IVF in the AR group at 3hrs and 6hrs from ED arrival and the need for BiPAP. There was no statistically significant association between receipt of >30 cc/kg of IVF in the AR group compared to the control group in terms of in-hospital mortality.
We identified a significant association of >30 cc/kg IVF administration and the need for Bi-PAP in AR patients. We identified higher in-hospital mortality in the AR group, but this was not associated with the amount of IVF resuscitation received.
congestive heart failure, sepsis, septic shock
Wiczorek M, Otero R, Knight S, Ziadeh K, Blumline J, Rollins Z. Outcomes for patients with congestive heart failure and chronic kidney disease receiving fluid resuscitation for severe sepsis or septic shock. Poster presented at: Oakland University William Beaumont School of Medicine Embark Capstone Colloquium; 2022 May 2; Rochester Hills, MI.
The Embark Capstone Colloquium at the Oakland University William Beaumont School of Medicine, Rochester Hills, MI, May 2, 2022.