Key result
A past history of heart failure was independently associated with receiving <30 mL/kg of IV fluids in septic patients, with no difference in mortality.
Why the study?
The underlying patient factors that affect intravenous fluid resuscitation in septic patients were not well defined.
Does a past medical history of heart failure affect the amount of intravenous fluid resuscitation administered in the first 24 hours and subsequent mortality in septic ICU patients?
Case-Control (n=181)
No
Does a past medical history of heart failure affect the amount of intravenous fluid resuscitation administered in the first 24 hours and subsequent mortality in septic ICU patients?
Answers are grounded in this paper and cite their sources.
Septic patients with a history of heart failure have more than twice the odds of receiving less than the guideline-recommended 30mL/kg IV fluid resuscitation in the first 24 hours, receiving approximately 1L less fluid without an observed difference in mortality.
OBJECTIVE: To identify the underlying factors that affect fluid resuscitation in septic patients. METHODS: The present study was a case-control study of 181 consecutive patients admitted to a Medical Intensive Care Unit between 2012 and 2016 with a diagnosis of sepsis. Demographic, clinical, radiological and laboratory data were analyzed. RESULTS: One hundred-thirty patients (72%) received ≥ 30mL/kg of IV fluids on admission. On univariate analyses, a past history of coronary artery disease and heart failure was associated with less fluid therapy. On multivariate analyses, a history of heart failure (OR = 2.31; 95%CI 1.04 - 5.14) remained significantly associated with receiving less IV fluids. Left ventricular ejection fraction, systolic/diastolic function, left ventricular hypertrophy and pulmonary hypertension were not associated with IV fluids. The amount of IV fluids was not associated with differences in mortality. During the first 24 hours, patients with a past history of heart failure received 2,900mLof IV fluids [1,688 - 4,714mL] versus 3,977mL [2,500 - 6,200mL] received by those without a history of heart failure, p = 0.02. CONCLUSION: Septic patients with a past history of heart failure received 1L less IV fluids in the first 24 hours with no difference in mortality.
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Palacios et al. (2019) conducted a case-control in Sepsis and septic shock (n=181). Past medical history of congestive heart failure vs. No past medical history of congestive heart failure was evaluated on Receiving < 30 mL/kg of IV fluids in the first 24 hours after diagnosis of sepsis (OR 2.31, 95% CI 1.04 - 5.14, p=0.03). A past history of heart failure was independently associated with receiving <30 mL/kg of IV fluids in septic patients, with no difference in mortality.
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