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Antecedentes de insuficiência cardíaca se associam a tratamento com menor volume de fluidos em pacientes sépticos

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OBJECTIVE To identify the underlying factors that affect fluid resuscitation in septic patients. METHODS The present study was a case-control study of 181 consecutive patients admitted to a Medical Intensive… Click to show full abstract

OBJECTIVE To identify the underlying factors that affect fluid resuscitation in septic patients. METHODS The present study was a case-control study of 181 consecutive patients admitted to a Medical Intensive Care Unit between 2012 and 2016 with a diagnosis of sepsis. Demographic, clinical, radiological and laboratory data were analyzed. RESULTS One hundred-thirty patients (72%) received ≥ 30mL/kg of IV fluids on admission. On univariate analyses, a past history of coronary artery disease and heart failure was associated with less fluid therapy. On multivariate analyses, a history of heart failure (OR = 2.31; 95%CI 1.04 - 5.14) remained significantly associated with receiving less IV fluids. Left ventricular ejection fraction, systolic/diastolic function, left ventricular hypertrophy and pulmonary hypertension were not associated with IV fluids. The amount of IV fluids was not associated with differences in mortality. During the first 24 hours, patients with a past history of heart failure received 2,900mLof IV fluids [1,688 - 4,714mL] versus 3,977mL [2,500 - 6,200mL] received by those without a history of heart failure, p = 0.02. CONCLUSION Septic patients with a past history of heart failure received 1L less IV fluids in the first 24 hours with no difference in mortality.

Keywords: past history; history heart; history; heart failure

Journal Title: Revista Brasileira De Terapia Intensiva
Year Published: 2019

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