• Brittany R Kiracofe-Hoyte, Bruce A Doepker, Heidi M Riha, Rachel Wilkinson, Elizabeth Rozycki, Eric Adkins, Amy Lehman, and Megan A Van Berkel.
• Department of Pharmacy, Spectrum Health, 100 Michigan St. NE, Grand Rapids, MI 49503, United States of America. Electronic address: brittany.kiracofe@spectrumhealth.org.
• J Crit Care. 2021 Jun 1; 63: 196-201.

PurposeAssess time to hemodynamic stability (HDS) in obese patients with septic shock who received <30 vs. ≥30 ml/kg of initial fluid resuscitation based on actual body weight (ABW).Materials And MethodsMulticenter, retrospective, cohort analysis of 322 patients.ResultsOverall 216 (67%) patients received <30 ml/kg of initial fluid resuscitation. Initial fluid received was lower in the <30 ml/kg vs. ≥30 ml/kg group (16 vs. 37 ml/kg). The ≥30 ml/kg group had shorter time to HDS (multivariable p = 0.038) and lower riskof in-hospital death (multivariable p = 0.038). An exploratory subgroup analysis (n = 227) was performed, classifying patients by dosing strategy [ABW, adjusted body weight (AdjBW), ideal body weight (IBW)] based on fluid received at 3 h divided by 30 ml/kg. ABW dosed patients had a shorter time to HDS (multivariable p = 0.013) and lower risk of in-hospital death (multivariable p = 0.008) vs. IBW. Similar outcomes were observed between ABW vs. AdjBW.ConclusionsObese patients given ≥30 ml/kg based on ABW had a shorter time to HDS and a lower risk of in-hospital death. Exploratory results suggest improved outcomes resuscitating by ABW vs. IBW; ABW showed no strong benefit over AdjBW. Further prospective studies are needed to confirm the optimal fluid dosing in obese patients.Copyright © 2020. Published by Elsevier Inc.

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