Timing of Dynamic Monitoring in Sepsis Fluid Resuscitation Affects Outcomes
By Nancy Melville
BRUSSELS -- September 3, 2021 -- Patients with septic shock who have dynamic measurement of stroke volume following a fluid challenge in the first two days show significantly greater improvements in outcomes and a lower risk of death compared with those receiving monitoring after 3 days, according to a study presented at the 40th International Symposium on Intensive Care and Emergency Medicine.
“The present results suggest that timing of resuscitation efforts is critically important, as patients who received earlier dynamic monitoring exhibited improved outcomes,” said Ivor Douglas, MD, Denver Health Medical Center, Denver, Colorado.
While IV fluid management is essential in patients with septic shock, there is a lack of clarity on recommendations on fluid resuscitation amid concerns that aggressive efforts could result in fluid overload and potential harms including damage to multiple organs or even death.
In previous research, the researchers determined that the dynamic measurement of stroke volume change and fluid responsiveness during a passive leg raise in patients with septic shock was safe and could importantly influence the amount of IV fluid provided in fluid resuscitation, while potentially improving outcomes, with reductions in net fluid balance and the risk of renal and respiratory failure. For the current study, they sought to determine if the outcomes could be influenced by the timing of the dynamic monitoring efforts.
The study included 1,123 patients with severe sepsis and septic shock in the 2013-2019 Premier Hospital Discharge database who had been admitted to an intensive care unit (ICU) from an emergency department and were later discharged from 19 hospitals. Of the patients, 42.2% were female and their mean age was 68.6 years.
Compared with patients who had monitoring initiated on day 3 or later, patients who had received dynamic monitoring of stroke volume on days 1 and 2 showed significantly shorter ICU stays (4.5 vs 10.7 days; PPP = .001).
“What this demonstrates is that in some US hospitals, this is being practiced, with some level of dynamic fluid measurements in the emergency department showing feasibility,” said Dr. Douglas. “There’s also an association with fluid outcomes, and what we need to work out is whether this is a causal effect or if it is being confounded by illness severity. So, this really warrants the kind of careful prospective analysis that we are planning in a larger trial.”
[Presentation title: Timing of Dynamic Measurement of Stroke Volume and Patient Outcome: Results From Examination of a Large Administrative Database. Abstract A113]