Piehl Mark, Adejumo Festus F, Maio Valerie De
Department of Pediatric Critical Care, WakeMed, Raleigh, NC.
University of North Carolina School of Medicine, Chapel Hill, NC.
Crit Care Explor. 2025 Apr 28;7(5):e1253. doi: 10.1097/CCE.0000000000001253. eCollection 2025 May 1.
Sepsis is the leading cause of inpatient mortality in the United States. The optimal timing and volume of fluid resuscitation for septic shock remain a topic of debate.
This study evaluated the effect of time to completion of at least 30 mL/kg of fluid and the impact of smaller fluid volumes on hospital outcomes among patients with septic shock.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study in a large community healthcare system (310,000 annual emergency visits) of all adults (age ≥ 18 yr) admitted from January 2017 to December 2022 with an International Classification of Diseases, 10th Revision diagnosis of sepsis and an initial emergency department (ED) systolic blood pressure (SBP) less than 90 mm Hg, mean arterial blood pressure less than 65 mm Hg, and/or lactate greater than or equal to 4 mmol/L.
The main outcomes include hospital mortality, ICU admission, mechanical ventilation, and vasopressor use. The relationship between time to completion of 30 mL/kg and the main outcomes was assessed using generalized linear models.
Among the 1602 patients who met inclusion criteria, 1190 (74.3%) received at least 30 mL/kg of fluid after ED arrival. The overall mortality rate was 24.2%, with 28.7% requiring mechanical ventilation and 64.3% requiring vasopressors. Receipt of at least 30 mL/kg between 2 and 3 hours from the time of initial ED SBP (time zero) was associated with lower odds of mortality (odds ratio [OR], 0.61; 95% CI, 0.39-0.97; p = 0.04) and mechanical ventilation use (OR, 0.43; 95% CI, 0.29-0.65; p < 0.01) compared with other intervals. Compared with receiving 30 mL/kg or greater, receiving at least 20 but less than 30 mL/kg within the first hour was associated with the lowest odds of mortality (OR, 0.33; 95% CI, 0.11-0.97; p = 0.04).
Our findings show that receipt of 30 mL/kg of fluid within 3 hours is associated with reduced mortality and the need for mechanical ventilation among patients with septic shock. These results support the current Surviving Sepsis Campaign fluid recommendations.
脓毒症是美国住院患者死亡的主要原因。感染性休克液体复苏的最佳时机和液体量仍是一个有争议的话题。
本研究评估了完成至少30 mL/kg液体输注的时间以及较少量液体对感染性休克患者医院结局的影响。
设计、地点和参与者：在一个大型社区医疗系统（每年310,000次急诊就诊）中进行的回顾性队列研究，研究对象为2017年1月至2022年12月期间入院的所有成年人（年龄≥18岁），其国际疾病分类第十版诊断为脓毒症，且初始急诊科（ED）收缩压（SBP）低于90 mmHg、平均动脉压低于65 mmHg和/或乳酸水平大于或等于4 mmol/L。
主要结局包括医院死亡率、入住重症监护病房（ICU）、机械通气和血管活性药物使用。使用广义线性模型评估完成30 mL/kg液体输注的时间与主要结局之间的关系。
在符合纳入标准的1602例患者中，1190例（74.3%）在ED就诊后接受了至少30 mL/kg的液体。总体死亡率为24.2%，28.7%的患者需要机械通气，64.3%的患者需要血管活性药物。与其他时间段相比，在初始ED SBP（时间零点）后2至3小时内接受至少30 mL/kg的液体与较低的死亡几率（优势比[OR]，0.61；95%置信区间[CI]，0.39 - 0.97；p = 0.04）和机械通气使用几率（OR，0.43；95% CI，0.29 - 0.65；p < 0.01）相关。与接受30 mL/kg或更多液体相比，在第一小时内接受至少20但少于30 mL/kg液体的患者死亡几率最低（OR，0.33；95% CI，0.11 - 0.97；p = 0.04）。
我们的研究结果表明，在3小时内接受30 mL/kg的液体与感染性休克患者死亡率降低及机械通气需求减少相关。这些结果支持当前拯救脓毒症运动的液体推荐。
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