Department of Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY, United States.
Department of Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY, United States.
Am J Emerg Med. 2021 Aug;46:416-419. doi: 10.1016/j.ajem.2020.10.037. Epub 2020 Oct 24.
Sepsis and bacterial infections are common in patients with end-stage renal disease (ESRD). We aimed to compare patients with ESRD on hemodialysis presenting to hospital with severe sepsis or septic shock who received <20 ml/kg of intravenous fluid to those who received ≥20 ml/kg during initial resuscitation.
We conducted a retrospective chart review of adult patients with ICD codes for discharge diagnosis of sepsis, severe sepsis, septic shock, ESRD, and hemodialysis admitted to our institution between 2015 and 2018.
We present outcomes for a total of 104 patients - 51 patients in conservative group and 53 in aggressive group. The mean age was 69.5 ± 11.2 years and 71 ± 11.5 years in the conservative group and aggressive group, respectively. There was no significant difference in the rate of ICU admission, and ICU or hospital length of stay between the two groups. Complications such as volume overload, rate of intubation, and urgent dialysis were not found to be significantly different.
We found that aggressive fluid resuscitation with ≥20 ml/kg may not be detrimental in the initial resuscitation of ESRD patients with SeS or SS. However, a clinical decision of volume responsiveness should be made on a case-by-case basis rather than a universal approach for fluid resuscitation in ESRD patients.
终末期肾病（ESRD）患者常发生脓毒症和细菌感染。本研究旨在比较在初始复苏期间接受 <20ml/kg 静脉补液与接受 ≥20ml/kg 静脉补液的 ESRD 血液透析患者因严重脓毒症或脓毒性休克住院的情况。
我们对 2015 年至 2018 年期间因脓毒症、严重脓毒症、脓毒性休克、ESRD 和血液透析的出院诊断 ICD 编码而入住我院的成年患者进行了回顾性图表审查。
共纳入 104 例患者，其中保守组 51 例，积极组 53 例。保守组和积极组的平均年龄分别为 69.5±11.2 岁和 71±11.5 岁。两组间 ICU 入院率、ICU 或住院时间均无显著差异。两组间并发症如容量超负荷、插管率和紧急透析率无显著差异。
我们发现，对于 SeS 或 SS 的 ESRD 患者，积极进行 ≥20ml/kg 的液体复苏可能不会产生不良影响。然而，应根据具体情况而非对所有 ESRD 患者进行普遍的液体复苏方法来做出容量反应性的临床决策。
