LAUSR

BACKGROUND Initial fluid resuscitation volume for sepsis is controversial, particularly in patients at high baseline risk for complications. This study was designed to assess the association between 30mL/kg crystalloids and intubation in patients with sepsis or septic shock and heart failure, end stage renal disease or cirrhosis. METHODS This propensity score-matched retrospective cohort study included patients with sepsis or septic shock admitted to a large medical intensive care unit. Primary exposure was intravenous fluid volume in the first 6 hours after sepsis diagnosis, which was divided into two cohorts; equal to or more than 30mL/kg (standard group) and less than 30mL/kg (restricted group). Primary outcome was need for mechanical ventilation within 72 hours after initiation of fluid resuscitation. Secondary outcomes were length of stay, ventilator days, and time to intubation. RESULTS A total of 208 patients were included, with 104 (50%) in both restricted (<30mL/kg) and standard (≥30mL/kg) groups. No difference in intubation incidence was detected between the two groups, with 36 patients (35%) in the restricted group and 33 (32%) in the standard group intubated (adjusted OR 0.74, 95% CI 0.41-1.3, p=0.34). There was no difference between standard and restricted groups in alive ICU-free days (17±11 days vs 17±10 days, p=0.64), duration of mechanical ventilation (10±12 days vs. 11±16 days, p=0.96), or hours to intubation (16±19 hours vs. 14±15, p=0.55). CONCLUSION We did not detect a difference in the incidence of intubation in septic patients with cirrhosis, ESRD and heart failure who received guideline-recommended fluid resuscitation with 30mL/kg compared to patients initially resuscitated with a lower fluid volume.