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Resuscitating patients with early severe sepsis: a Canadian multicentre observational study

[Réanimation des patients en début de sepsie sévère : une étude observationnelle multi-centrique canadienne]

Lauralyn A. McIntyre, MD^*,, Dean Fergusson, PhD^,, Deborah J. Cook, MD, Rama C. Nair, PhD, Dean Bell, MD^¶, Viinay Dhingra, MD^||, Brian Hutton, MSc^,, Sheldon Magder, MD^**, Paul C. Hébert, MHSc^*,, for The Canadian Critical Care Trials Group

^* From Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, Ontario;
Ottawa Health Research Institute, Ottawa, Ontario;
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario,
McMaster University, London, Ontario;
^¶ University of Manitoba, Winnipeg, Manitoba;
^|| University of British Columbia, Vancouver, British Columbia; and
^** McGill University, Montreal, Quebec, Canada.

Address correspondence to: Dr. Lauralyn McIntyre, Box 201, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. E-mail: lmcintyre{at}ottawahospital.on.ca

Background: Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure.

Methods: A retrospective, multicentre cohort study was undertaken at five Canadian tertiary care ICUs. We identified patients with severe sepsis admitted to the ICU between July 1, 2000, and June 30, 2002, using both administrative and clinical databases. Patients were included if they were hypotensive, had an infectious source, and at least two systemic inflammatory response syndrome criteria. We recorded total quantity and type of fluid administered for the first six hours after severe sepsis was identified. The first episode of hypotension defined the starting point for collection of fluid data. Multivariable regression analyses were performed to examine associations between quantity and type of fluid administered and hospital/ICU mortality, and organ failure.

Results: Of 2,026 potentially eligible patient charts identified, 496 patients met eligibility criteria. The mean age and Acute Physiology and Chronic Health Evaluation score (APACHE II) were 61.8 ± 16.5 yr and 29.0 ± 8.0, respectively. No associations between quantity or type of fluid administered and hospital mortality or ICU mortality were identified, and there were no statistically significant associations between quantity or type of fluid administered and organ failure. However, more fluid resuscitation was associated with an increased risk of cardiovascular failure [odds ratio (OR) and 95% confidence interval (CI)] for 2–4 L 1.67 (1.03–2.70) and > 4 L 2.34 (1.23–4.44) and a reduced risk of renal failure [OR, 95% CI for 2–4 L 0.48 (0.28–0.83) and > 4 L 0.45 (0.22–0.92)] in the first 24 hr of severe sepsis. Administration of colloid and crystalloid fluid as compared to crystalloid fluid alone was associated with a lower risk of renal failure [OR, 95% CI 0.45 (0.26 to 0.76)].

Conclusion: An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.

Related articles in CJA:

Severe sepsis: a bundle still under construction?/La septicémie sévère: un lot encore en travaux ?

Robert N. Sladen
CJA 2007 54: 779-785. [Full Text]  

This article has been cited by other articles:

				R. N. Sladen Severe sepsis: a bundle still under construction?/La septicemie severe: un lot encore en travaux ? Can J Anesth, October 1, 2007; 54(10): 779 - 785. [Full Text] [PDF]