Abstract
Background
Septic shock is associated with hypovolemia resulting in organs failure and poor prognosis.
The first step in hemodynamic resuscitation relies on early fluid expansion. In this
study, we describe qualitative and quantitative fluid resuscitation of septic shock
initially managed in a pre-hospital setting by a mobile intensive care unit.
Methods
Patients with septic shock who received pre-hospital medical care were retrospectively
analysed. Qualitative and quantitative fluid resuscitation performed in the pre-hospital
setting were analysed. Applying the "grey zone" concept, we define 3 categories of
fluid expansion indexed on ideal body weight (IBW): >20ml/kg, 10-20ml/kg and < 10ml/kg.
The relationship between the pre-specified categories and mortality at day 28 were
analyzed.
Results
Ninety-five patients were included. The origin of sepsis was mainly pulmonary (68%).
Mortality reached 34%. Pre-hospital fluid expansion was performed using serum saline
(98%) with a mean of 1158±559ml. An inversed linear relationship between pre-specified
categories and mortality was observed. Using logistic regression model, significant
association with mortality remained for fluid expansion indexed on IBW: p=0.02, ORa
[CI95] = 0.93 [0.89-0.98]. For fluid expansion indexed on IBW < 10ml/kg, the OR [CI95]
was 4.03 [1.78-9.41] (p=0.005) whereas for fluid expansion indexed on IBW > 20ml/kg,
the OR [CI95] was 0.30 [0.13-0.66] (p=0.01).
Discussion
Pre-hospital fluid resuscitation in septic shock is mainly performed using crystalloids
with quantitative fluid expansion lower than recommended. Low pre-hospital fluid expansion
was associated with increased mortality. Further prospective studies are needed to
evaluate the impact of optimized early fluid expansion on mortality in the prehospital
management of septic shock.
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Article Info
Publication History
Published online: February 03, 2018
Accepted:
January 24,
2018
Received in revised form:
January 18,
2018
Received:
January 2,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
