title: Volume of fluids administered during resuscitation for severe sepsis and septic shock and the development of the acute respiratory distress syndrome.
abstract: OBJECTIVE
  The purpose of this study was to examine the association between the volume of intravenous (IV) fluids administered in the resuscitative phase of severe sepsis and septic shock and the development of the acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  This was a retrospective cohort study of adult patients admitted with severe sepsis and septic shock at a large academic public hospital. The relationship between the volume of IV fluids administered and the development of ARDS was examined using multivariable logistic regression analysis.
  
  
  RESULTS
  Among 296 patients hospitalized for severe sepsis and septic shock, 75 (25.3%) developed ARDS. After controlling for confounding variables, there was no significant association between the volume of IV fluids administered in the first 24 hours of hospitalization and the development of ARDS (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.95-1.18). Serum albumin (OR, 0.52; 95% CI, 0.31-0.87) and Acute Physiology and Chronic Health Evaluation II score (OR, 1.08; 95% CI, 1.04-1.13) on admission were the most informative covariates for the development of ARDS in the regression model.
  
  
  CONCLUSIONS
  For patients hospitalized for severe sepsis and septic shock, fluid administration to improve end-organ perfusion should remain the top priority in early resuscitation despite the potential risk of inducing ARDS.
authors.affiliation: Divisions of Respiratory and Critical Care Physiology and Medicine, Los Angeles County Department of Health Services and Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA. Electronic address: dchang@labiomed.org.
authors.forename: Dong W
authors.initials: DW
authors.lastname: Chang
authors.affiliation: Divisions of Respiratory and Critical Care Physiology and Medicine, Los Angeles County Department of Health Services and Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Huynh
authors.affiliation: Divisions of Respiratory and Critical Care Physiology and Medicine, Los Angeles County Department of Health Services and Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Sandoval
authors.affiliation: Divisions of Respiratory and Critical Care Physiology and Medicine, Los Angeles County Department of Health Services and Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
authors.forename: Neung
authors.initials: N
authors.lastname: Han
authors.affiliation: Department of Medicine and the Department of Emergency Medicine, Los Angeles County Department of Health Services and Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Coil
authors.affiliation: General Internal Medicine, Los Angeles County Department of Health Services and Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Spellberg
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D012151:Resuscitation; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000628:therapy
keywords: Acute respiratory distress syndrome; Fluid balance; Resuscitation; Sepsis