Initial fluid resuscitation of patients with septic shock in the intensive care unit.

摘要

BACKGROUND: Fluid is the mainstay of resuscitation of patients with septic shock, but the optimal composition and volume are unknown. Our aim was to evaluate the current initial fluid resuscitation practice in patients with septic shock in the intensive care unit (ICU) and patient characteristics and outcome associated with fluid volume. METHODS: This was a prospective, cohort study of all patients with septic shock (n=132) admitted in six ICUs during a 3-month period. Patients were divided into two groups according to the overall median volume of resuscitation fluid administered during the first 24 h after the diagnosis. Baseline characteristics, other treatments, monitoring and outcome were compared between the groups. RESULTS: The mean volume of resuscitation fluid was 4.9 l (median 4.0 l and SD 3.5). Patients in the higher volume group received more crystalloids (3.7 vs. 1.2 l, P<0.0001), colloids (1.8 vs. 0.9 l, P<0.0001), blood products (1.8 vs. 0.6 l, P=0.0004), a higher maximum vasopressor dose (0.37 vs. 0.21 mug/kg/min, P<0.0001) and had a higher initial plasma concentration of lactate (4.0 vs. 3.0 mM, P=0.009) compared with the lower volume group. Simplified acute physiology score II in the lower and higher dose group were 52 and 58 (P=0.07). There were no differences in 30-, 90- or 365-day mortality between the two fluid volume groups. CONCLUSION: In the ICU, patients with septic shock were resuscitated with a combination of crystalloids, colloids and blood products. Although the more severely shocked patients received higher volumes of crystalloids, colloids and blood products, mortality did not differ between the groups.