Sepsis, the Administration of IV Fluids, and Respiratory Failure: A Retrospective Analysis—SAIFR Study

Nikhil Jagan, Lee E. Morrow, Ryan W. Walters, Robert W. Plambeck, Tej M. Patel, Karson F. Kalian, Jeffrey C. Macaraeg, Emily D. Dyer, Adam A. Bergh, Aaron J. Fried, Douglas R. Moore, Mark A. Malesker

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although resuscitation with IV fluids is the cornerstone of sepsis management, consensus regarding their association with improvement in clinical outcomes is lacking. Research Question: Is there a difference in the incidence of respiratory failure in patients with sepsis who received guideline-recommended initial IV fluid bolus of 30 mL/kg or more conservative resuscitation of less than 30 mL/kg? Study Design and Methods: This was a retrospective analysis of prospectively collected clinical data conducted at an academic medical center in Omaha, Nebraska. We abstracted data from 214 patients with sepsis admitted to a single academic medical center between June 2017 and June 2018. Patients were stratified by receipt of guideline-recommended fluid bolus. The primary outcome was respiratory failure defined as an increase in oxygen flow rate or more intense oxygenation and ventilation support; oxygen requirement and volume were measured at admission, 6 h, 12 h, 24 h, and at discharge. Subgroup analyses were conducted in high-risk patients with congestive heart failure (CHF) as well as those with chronic kidney disease (CKD). Results: A total of 62 patients (29.0%) received appropriate bolus treatment. The overall rate of respiratory failure was not statistically different between patients who received appropriate bolus or did not (40.3% vs 36.8%; P =. 634). Likewise, no differences were observed in time to respiratory failure (P =. 645) or risk of respiratory failure (adjusted hazard ratio, 1.1 [95% CI, 0.7-1.7]; P =. 774). Results were similar within the high-risk CHF and CKD subgroups. Interpretation: In this single-center retrospective study, we found that by broadly defining respiratory failure as an increase in oxygen requirements, a conservative initial IV fluid resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure.

Original languageEnglish (US)
Pages (from-to)1437-1444
Number of pages8
JournalChest
Volume159
Issue number4
DOIs
StatePublished - Apr 2021

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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