Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, United States of America.
RN-BSN Program, Fayetteville State University, Fayetteville, NC, United States of America.
PLoS One. 2021 Aug 19;16(8):e0256368. doi: 10.1371/journal.pone.0256368. eCollection 2021.
The use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data.
The retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation.
The use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82-0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93-1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90-0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus.
The use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.
在患有充血性心力衰竭 (CHF) 的出现严重脓毒症或脓毒性休克的患者中，使用 ≥30mL/Kg 的液体冲击量仍存在争议，因为数据有限。
这项回顾性病例对照研究纳入了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间因严重脓毒症或脓毒性休克到三级护理医院急诊科就诊的 671 例成年患者。患者分为 CHF 组和非 CHF 组。主要结局是评估在出现后 6 小时内使用 ≥30mL/Kg 液体冲击量的符合率。比较了两组患者接受 ≥30mL/Kg 液体冲击量的基线特征和次要结局。对 CHF 组进行亚组分析，根据是否给予 ≥30mL/Kg 液体冲击量进行分组，并比较基线特征和次要结局。对住院死亡率和机械通气进行单变量和多变量分析，以探讨组间差异。
CHF 组和非 CHF 组使用 ≥30mL/Kg 液体冲击量的比例均较低[39% vs. 66%（p<0.05）]。CHF 组死亡率较高[33% vs. 18%（p<0.05）]。多变量分析显示，使用 ≥30mL/Kg 液体冲击量可使死亡率降低 12%[比值比 0.88，95%置信区间 0.82-0.95（p<0.05）]。使用 ≥30mL/Kg 液体冲击量不会增加机械通气的可能性[比值比 0.99，95%置信区间 0.93-1.05（p=0.78）]。在亚组分析中，使用 ≥30mL/Kg 液体冲击量可使死亡率降低 5%[比值比 0.95，95%置信区间 0.90-0.99（p<0.05）]，且不会增加机械通气的可能性。低射血分数的存在并不影响获得液体冲击量的机会。
在患有严重脓毒症或脓毒性休克的心力衰竭患者中，使用 ≥30mL/Kg 的液体冲击量似乎可降低住院死亡率，且与机械通气发生率增加无关。
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