• Nikhil Jagan, Lee E Morrow, Ryan W Walters, Robert W Plambeck, Tej M Patel, Karson F Kalian, Jeffrey C Macaraeg, Emily D Dyer, Adam A Bergh, Aaron J Fried, Douglas R Moore, and Mark A Malesker.
• From the Division of Pulmonary & Critical Care, Omaha, NE. Electronic address: nikhiljagan@creighton.edu.
• Chest. 2021 Apr 1; 159 (4): 1437-1444.

BackgroundAlthough resuscitation with IV fluids is the cornerstone of sepsis management, consensus regarding their association with improvement in clinical outcomes is lacking.Research QuestionIs there a difference in the incidence of respiratory failure in patients with sepsis who received guideline-recommended initial IV fluid bolus of 30 mL/kg or more conservative resuscitation of less than 30 mL/kg?Study Design And MethodsThis was a retrospective analysis of prospectively collected clinical data conducted at an academic medical center in Omaha, Nebraska. We abstracted data from 214 patients with sepsis admitted to a single academic medical center between June 2017 and June 2018. Patients were stratified by receipt of guideline-recommended fluid bolus. The primary outcome was respiratory failure defined as an increase in oxygen flow rate or more intense oxygenation and ventilation support; oxygen requirement and volume were measured at admission, 6 h, 12 h, 24 h, and at discharge. Subgroup analyses were conducted in high-risk patients with congestive heart failure (CHF) as well as those with chronic kidney disease (CKD).ResultsA total of 62 patients (29.0%) received appropriate bolus treatment. The overall rate of respiratory failure was not statistically different between patients who received appropriate bolus or did not (40.3% vs 36.8%; P = .634). Likewise, no differences were observed in time to respiratory failure (P = .645) or risk of respiratory failure (adjusted hazard ratio, 1.1 [95% CI, 0.7-1.7]; P = .774). Results were similar within the high-risk CHF and CKD subgroups.InterpretationIn this single-center retrospective study, we found that by broadly defining respiratory failure as an increase in oxygen requirements, a conservative initial IV fluid resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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