Recommended Reading from the Loyola University Medical Center Pulmonary and Critical Care Fellowship Program

摘要

The Surviving Sepsis guidelines recommend targeting fluid resuscitation to central venous pressure (CVP) of 8 to 12 mm Hg (1). Recent studies show increasing morbidity and mortality in intensive care unit (ICU) patients with a positive fluid balance (2). The current study adds to the conundrum as to the best fluid management strategy in patients with septic shock. The authors performed a retrospective review of 778 septic patients on norepinephrine from the Vasopressin in Septic Shock Trial and examined the effect of a positive fluid balance at 12 and 96 hours on 28-day mortality (3). Patients were divided into quartiles of average fluid balance and into three groups of CVP measurements: less than 8 mm Hg, 8 to 12 mm Hg, and greater than 12 mm Hg, with hazard ratios measured relative to the highest net fluid positive quartile and highest CVP group, respectively. The analysis was adjusted for age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and dose of noreoineohrine.