Effects of fluid restriction on measures of circulatory efficacy in adults with septic shock.
BACKGROUND
The haemodynamic consequences of fluid resuscitation in septic shock have not been fully elucidated. Therefore, we assessed circulatory effects in the first 24 h of restriction of resuscitation fluid as compared to standard care in intensive care unit (ICU) patients with septic shock.


METHODS
This was a post-hoc analysis of the multicentre CLASSIC randomised trial in which patients with septic shock, who had received the initial fluid resuscitation, were randomised to a protocol restricting resuscitation fluid or a standard care protocol in nine ICUs. The highest plasma lactate, highest dose of noradrenaline, and the urinary output were recorded in five time frames in the first 24 h after randomisation. We used multiple linear mixed effects models to compare the two groups.


RESULTS
We included all 151 randomised patients; the cumulated fluid resuscitation volume in the first 24 h after randomisation was median 500 ml (Interquartile range (IQR) 0-1500) and 1250 ml (500-2500) in the fluid restriction group and standard care group, respectively. The estimated differences in the fluid restriction group vs. the standard care group were 0.1 mM (95% confidence interval -0.7 to 0.9; P = 0.86) for lactate, 0.01 μg/kg/min (-0.02 to 0.05; P = 0.48) for dose of noradrenaline, and -0.1 ml/kg/h (-0.3 to 0.2; P = 0.70) for urinary output during the first 24 h after randomisation.


CONCLUSIONS
We observed no indications of worsening of measures of circulatory efficacy in the first 24 h of restriction of resuscitation fluid as compared with standard care in adults with septic shock who had received initial resuscitation.
Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
P B
PB
Hjortrup
Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
N
N
Haase
Copenhagen Trial Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
J
J
Wetterslev
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.|Center for Statistical Science, Peking University, Peking, China.
T
T
Lange
Department of Intensive Care, Randers Hospital, Randers, Denmark.
H
H
Bundgaard
Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
B S
BS
Rasmussen
Department of Intensive Care, Herning Hospital, Herning, Denmark.
N
N
Dey
Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland.
E
E
Wilkman
Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark.
L
L
Christensen
Department of Intensive Care, Holstebro Hospital, Holstebro, Denmark.
D
http://orcid.org/0000-0001-8475-8115
D
Lodahl
Department of Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark.
M
M
Bestle
Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
A
A
Perner
D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation; D003422:Critical Care; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy*; D014563:Urodynamics / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D009638:Norepinephrine