Volume of fluids administered during resuscitation for severe sepsis and septic shock and the development of the acute respiratory distress syndrome

• Published in: Journal of critical care 2014-12, Vol.29 (6), p.1011-1015
• Main Authors: Chang, Dong W., MD, Huynh, Richard, MD, Sandoval, Eric, MD, Han, Neung, MD, Coil, Clinton J., MD, MPH, Spellberg, Brad J., MD
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Aged; APACHE; Biomedical research; Blood products; Comorbidity; Critical Care; Ethnicity; Female; Fluid balance; Fluid Therapy - adverse effects; Fluid Therapy - statistics & numerical data; Fluids; Heart rate; Hospitalization; Hospitals; Humans; Infusions, Intravenous; Intensive care; Laboratories; Male; Middle Aged; Mortality; Patients; Regression Analysis; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - etiology; Resuscitation; Retrospective Studies; Sepsis; Sepsis - blood; Sepsis - therapy; Shock, Septic - blood; Shock, Septic - therapy; Studies
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.06.005

Abstract Purpose The purpose of this study was to examine the association between the volume of intravenous (IV) fluids administered in the resuscitative phase of severe sepsis and septic shock and the development of the acute respiratory distress syndrome (ARDS). Materials and methods This was a retrospective cohort study of adult patients admitted with severe sepsis and septic shock at a large academic public hospital. The relationship between the volume of IV fluids administered and the development of ARDS was examined using multivariable logistic regression analysis. Results Among 296 patients hospitalized for severe sepsis and septic shock, 75 (25.3%) developed ARDS. After controlling for confounding variables, there was no significant association between the volume of IV fluids administered in the first 24 hours of hospitalization and the development of ARDS (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.95-1.18). Serum albumin (OR, 0.52; 95% CI, 0.31-0.87) and Acute Physiology and Chronic Health Evaluation II score (OR, 1.08; 95% CI, 1.04-1.13) on admission were the most informative covariates for the development of ARDS in the regression model. Conclusions For patients hospitalized for severe sepsis and septic shock, fluid administration to improve end-organ perfusion should remain the top priority in early resuscitation despite the potential risk of inducing ARDS.