Chest
Critical Care: Original ResearchSepsis, the Administration of IV Fluids, and Respiratory Failure: A Retrospective Analysis—SAIFR Study
Section snippets
Study Design and Patients
This study was considered exempt research by the Creighton University Institutional Review Board (IRBNet Identification: 1304684-2). We retrospectively identified all hospital admissions between June 2017 and June 2018 to CHI Health Creighton University Medical Center—Bergan Mercy, Omaha, NE, that included an International Classification of Diseases, Ninth or Tenth Revision, diagnosis code for sepsis and septic shock and who qualified for the 30-mL/kg fluid bolus as set forth by the Centers for
Results
A total of 244 eligible admissions were identified in which the patient was 19 years of age or older and met inclusion criteria. We excluded patients missing clinical characteristics (n = 13 [5.3%]), any subsequent admissions during the study period (n = 6 [2.5%]), and patients who were intubated before the initial fluid bolus administration (n = 12 [4.9%]). Our final sample consisted of 214 unique patients, of whom 184 (86.0%) had unspecified sepsis cause (e-Tables 1, 2).
Overall, patients
Discussion
Early, aggressive IV fluid administration has been the cornerstone of sepsis management since the inaugural publication of the SSC guidelines.16 This practice is embraced so widely that compliance with the SSC bundle—including a 30-mL/kg bolus in the first 3 h—is a quality measure and noncompliance is reimbursed punitively by the Centers for Medicare and Medicaid Services,9 although this is a point of contention among clinicians. First, this is because no definitive evidence has established
Acknowledgments
Author contributions: N. J. is the guarantor of the content of the manuscript, including the data and analysis. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. N. J., L. E. M., R. W. W., R. W. P., T. M. P., K. F. K., J. C. M., E. D. D., A. A. B., A. J. F., D. R. M., and M. A. M. contributed substantially to the study design; data collection,
References (23)
- et al.
The changing epidemiology and definitions of sepsis
Clin Chest Med
(2016) - et al.
Association between volume of fluid resuscitation and intubation in high-risk patients with sepsis, heart failure, end-stage renal disease, and cirrhosis
Chest
(2020) - et al.
Lower versus higher fluid volumes during initial management of sepsis–a systematic review with meta-analysis and trial sequential analysis
Chest
(2020) - et al.
Association of fluid resuscitation initiation within 30 minutes of severe sepsis and septic shock recognition with reduced mortality and length of stay
Ann Emerg Med
(2016) - et al.
Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock
J Crit Care
(2015) - et al.
Fluid resuscitation in severe sepsis
Emerg Med Clin
(2017) - et al.
The epidemiology of sepsis in the United States from 1979 through 2000
N Engl J Med
(2003) - et al.
Hospital deaths in patients with sepsis from 2 independent cohorts
JAMA
(2014) - et al.
Epidemiology of severe sepsis
Virulence
(2014) - et al.
Early goal-directed therapy in the treatment of severe sepsis and septic shock
N Engl J Med
(2001 Nov 8)
A randomized trial of protocol-based care for early septic shock
N Engl J Med
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.