Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study.
BACKGROUND
The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time.


METHODS
This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009. Data were collected from a previously validated electronic medical database. Multivariate regression modeling was performed, adjusting for age, admission weight, Sequential Organ Failure Assessment score, APACHE (Acute Physiology and Chronic Health Examination) III score, and total fluid administration within the first 6 h of sepsis onset time.


RESULTS
Of 651 patients with severe sepsis and septic shock screened, 594 had detailed fluid data. In a univariate analysis, the median amount of fluid within the first 3 h for survivors at discharge was 2,085 mL (940-4,080 mL) and for nonsurvivors, 1,600 mL (600-3,010 mL; P = .007). In comparison, during the latter 3 h, the median amount was 660 mL (290-1,485 mL) vs 800 mL (360-1,680 mL; P = .09), respectively. After adjusting for confounders, the higher proportion of total fluid received within the first 3 h was associated with decreased hospital mortality (OR, 0.34; 95% CI, 0.15-0.75; P = .008).


CONCLUSIONS
Earlier fluid resuscitation (within the first 3 h) is associated with a greater number of survivors with severe sepsis and septic shock.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Sarah J
SJ
Lee
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Kannan
K
Ramar
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
John G
JG
Park
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Ognjen
O
Gajic
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Guangxi
G
Li
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Kashyap.Rahul@mayo.edu.
Rahul
R
Kashyap
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*