Fluid resuscitation and initial management in patients presenting sepsis on general ward

초록

Background and Aims: 10% to 20% of sepsis and septic shock occur in hospitalized patients, and their mortality is higher than that of patients presenting sepsis at admission. Suboptimal fluid resuscitation may contribute to poor outcome in these patients. We investigated initial sepsis management in patients presenting sepsis on general ward, and association between resuscitation fluid volume and clinical outcomes Methods: This is a single-center, retrospective study. Patients who presented sepsis-induced hypotension on general ward and transferred to intensive care unit (ICU) were included. We divided patients into insufficient resuscitation group (<30 mL/kg) and sufficient resuscitation group (≥30 mL/kg) according to the total resuscitation fluid volume per body weight within first 3 h, and compared them. Multivariable logistic regression analysis was performed to investigate the effect of fluid resuscitation on ICU mortality. Results: Ninety patients were included in final analysis. Seventy-nine patients belonged to insufficient resuscitation group, and 11 to sufficient resuscitation group. Median total resuscitation fluid volume was 500 mL (9.2 mL/kg) in insufficient resuscitation group, and 2000 mL (35.9 mL/kg) in sufficient resuscitation group. The ICU mortality did not differ between two groups (43.0% vs. 45.5%, p > 0.999). Twenty-two patients in insufficient resuscitation group received continuous renal replacement therapy (CRRT), whereas no one in sufficient resuscitation group (27.8% vs. 0%, p = 0.059). Conclusion: Most patients presenting sepsis on general ward received insufficient fluid resuscitation. Use of CRRT was more frequent in the insufficient resuscitation group, but ICU mortality was similar in both groups.