LAUSR

METHODS: A single center retrospective cohort study evaluated patients with a diagnosis of sepsis or septic shock with underlying compensated diastolic and/or systolic CHF. Study populations were divided into 2 groups: liberal IVF and restrictive IVF resuscitation. Primary outcome of interest was the incidence of endotracheal intubation while secondary outcomes were mortality, length of stay (LOS), and 30-day readmission rate. Total (n) of 83 patients met inclusion and exclusion criteria. 39 CHF patients underwent liberal IVF resuscitation; 14 systolic, 24 diastolic, 1 combined. Meanwhile 44 CHF patients underwent restrictive IVF resuscitation; 19 systolic, 24 diastolic, 1 combined. There were no hemodialysis-dependent or patients with liver cirrhosis. RESULTS: In the liberal group, 23% required endotracheal intubation compared to 9% in the restrictive group. Diastolic dysfunction comprised 88% of the intubated patients in liberal group, and 75% of the intubated patients in the restrictive group (p value <0.001). Mortality was 17% in the liberal group (42% systolic dysfunction, 58% diastolic dysfunction) and 34% in the restrictive group (33.3% systolic dysfunction, 66.6% diastolic dysfunction) (p value 0.0027). 30-day readmission was 28% in the liberal group versus 13% in the restrictive group (p value <0.001). LOS was 9.03 þ/5.4 days for liberal group versus 8.5 þ/4.6 days in the restrictive group (p value 0.06). CONCLUSIONS: Our study shows that CHF patients with sepsis that were treated with liberal IVF resuscitation were 2.5-times more likely to require endotracheal intubation. This is especially true for diastolic dysfunction who were 7-times more likely in liberal and 3-times more likely in restrictive IVF resuscitation. When patients underwent restrictive method, mortality was double that of liberal resuscitation. Our findings support current sepsis guidelines in patients with CHF to reduce mortality at the expense of respiratory failure requiring invasive ventilator support. CLINICAL IMPLICATIONS: This study supports guideline recommendations that liberal IVF resuscitation in septic CHF patients significantly reduces mortality. DISCLOSURES: No relevant relationships by Victoria Gonzalez, source1⁄4Web Response No relevant relationships by Lina Masso, source1⁄4Web Response No relevant relationships by Manishkumar Patel, source1⁄4Web Response No relevant relationships by Mulham Shikh Hamdon, source1⁄4Web Response No relevant relationships by Toribiong Uchel, source1⁄4Web Response DOI: http://dx.doi.org/10.1016/j.chest.2019.08.1505 Copyright a 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. hestjournal.org 1719A