The following is a summary of “Fluid boluses and infusions in the early phase of resuscitation from septic shock and sepsis-induced hypotension: a retrospective report and outcome analysis from a tertiary hospital,” published in the August 2024 issue of Critical Care by Messina et al.

Fluid administration is a first-line treatment of individuals with sepsis leading to septic shock in intensive care units (ICU). Fluid bolus administration might be titrated by predicting preload dependency. 

Researchers conducted a retrospective study to assess the ratio between fluid boluses and total administered fluid intake during ICU stay and to evaluate the impact of fluid strategy on ICU mortality. 

They exported data on fluid administration during the first 4 days of ICU stay from an electronic health record (EHR) (ICCA®, Philips Healthcare). Demographic data, severity score, norepinephrine dose at admission, overall fluid balance, and the percentage of other fluid components were examined in a multivariable logistic regression model to evaluate the association with ICU survival.

The results showed fluid boluses and maintenance of 220 patients with septic shock and sepsis from July 2021 to December 2023, representing 49.3% ± 22.8% of the overall fluid intake. The balanced solution represented the most (40.4% ± 22.0) of 220 patients admitted. The fluid volume for drug infusion accounted for 34.0% ± 2.9% of the total fluid intake, while oral fluid intake represented 18.0% ± 15.7%. Fluid volume given as boluses constituted 8.6% of the total fluid intake over the four days, decreasing from 25.1% ± 24.0% to 4.8% ± 8.7% on Day 1 to 4. A positive fluid balance [OR 1.167 (1.029–1.341); P=0.021] was identified as the critical factor associated with ICU mortality. Non-survivors (n = 66; 30%) had more inputs than survivors of Day 1 [2493 mL vs. 1855 mL; P= 0.022].

They concluded the fluids given in the early detection of septic shock and sepsis-induced hypotension showed an overall volume given by boluses ranging from about 25% to 5% on Day 1 to 4 from ICU admission, and it also confirms fluid balance for the first 4 days of ICU associated with mortality.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01347-6