Pre-operative fluid resuscitation in the emergency general surgery septic patient: does it really matter?

摘要

Emergency general surgery (EGS) patients presenting with sepsis remain a challenge. The Surviving Sepsis Campaign recommends a 30?mL/kg fluid bolus in these patients, but recent studies suggest an association between large volume crystalloid resuscitation and increased mortality. The optimal amount of pre-operative fluid resuscitation prior to source control in patients with intra-abdominal sepsis is unknown. This study aims to determine if increasing volume of resuscitation prior to surgical source control is associated with worsening outcomes. We conducted an 8-year retrospective chart review of EGS patients undergoing surgery for abdominal sepsis within 24?h of admission. Patients in hemorrhagic shock and those with outside hospital index surgeries were excluded. We grouped patients by increasing pre-operative resuscitation volume in 10?ml/kg intervals up to ?70?ml/kg and later grouped them into 30?ml/kg (p?=?0.02). These groups had median qSOFA scores (1.0 vs. 1.0, p?=?0.06). There were no differences in time to operation (6.1 vs 4.9?h p?=?0.11), ventilator days (1 vs 3, p?=?0.08), or hospital LOS (8 vs 9?days, p?=?0.57). Relative risk regression correcting for age and physiologic factors showed no significant differences in mortality between the fluid groups. Greater pre-operative resuscitation volumes were initially associated with significantly higher mortality, despite similar organ failure scores. However, fluid volumes were not associated with mortality following adjustment for other physiologic factors in a regression model. The amount of pre-operative volume resuscitation was not associated with differences in time to operation, ventilator days, ICU or hospital LOS.