Focused Cardiac Ultrasound Findings of Fluid Tolerance and Fluid Resuscitation in Septic Shock

Ina G Prevalska; Ryan V Tucker; Peter C England; Christopher M Fung

doi:10.1097/CCE.0000000000001015

Focused Cardiac Ultrasound Findings of Fluid Tolerance and Fluid Resuscitation in Septic Shock

Crit Care Explor. 2023 Dec 1;5(12):e1015. doi: 10.1097/CCE.0000000000001015. eCollection 2023 Dec.

Authors

Ina G Prevalska¹, Ryan V Tucker¹, Peter C England^{1

2}, Christopher M Fung^{1

3}

Affiliations

¹ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.
² Department of Anesthesiology, Critical Care, University of Michigan, Ann Arbor, MI.
³ Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI.

Abstract

Objectives: Compliance with the fluid bonus component of the SEP-1 (severe sepsis and septic shock management) bundle remains poor due to concerns for iatrogenic harm from fluid overload. We sought to assess whether patients who received focused cardiac ultrasound (FCU) and were found to be fluid tolerant (FT) were more likely to receive the recommended 30 mL/kg fluid bolus within 3 hours of sepsis identification.

Design: Retrospective, observational cohort study.

Setting: University-affiliated, tertiary-care hospital in the United States.

Patients: Emergency department patients presenting with septic shock from 2018 to 2021. The primary exposure was receipt of FCU with identification of fluid tolerance 3 hours from onset of septic shock.

Interventions: None.

Measurements and main results: Two hundred ninety-two of 1,024 patients with septic shock received FCU within 3 hours of sepsis onset. One hundred seventy-seven were determined to be FT. One hundred fifteen patients were determined to have poor fluid tolerance (pFT). FT patients were more likely to reach the recommended 30 mL/kg fluid bolus amount compared with pFT (FT 52.0% vs. pFT 31.3%, risk difference: 20.7%, [95% CI, 9.4-31.9]). Patients who did not receive FCU met the bolus requirement 34.3% of the time. FT patients received more fluid within 3 hours (FT 2,271 mL vs. pFT 1,646 mL, mean difference 625 mL [95% CI, 330-919]). Multivariable logistic regression was used to estimate the association between fluid tolerance FCU findings and compliance with 30 mL/kg bolus after adjustment for patient characteristics and markers of hemodynamic instability. FT with associated with a higher likelihood of meeting bolus requirement (odds ratio 2.17 [1.52-3.12]).

Conclusions: Patients found to be FT by FCU were more likely to receive the recommended 30 mL/kg bolus in the SEP-1 bundle when compared with patients found with pFT or those that did not receive FCU. There was no difference between groups in 28-day mortality, vasopressor requirement, or need for mechanical ventilation.

Keywords: cardiac; echocardiography; fluid; resuscitation; sepsis; septic; shock; ultrasound.

Grants and funding

K12 HL133304/HL/NHLBI NIH HHS/United States