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Randomized Controlled Trial
. 2016 May 19;11(5):e0155767.
doi: 10.1371/journal.pone.0155767. eCollection 2016.

Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis: Post Hoc Analyses of Data from a Multicentre Randomised Clinical Trial

Peter Buhl Hjortrup  1 , Nicolai Haase  1 , Jørn Wetterslev  2 , Anders Perner  1   3
Affiliations
Randomized Controlled Trial

Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis: Post Hoc Analyses of Data from a Multicentre Randomised Clinical Trial

Peter Buhl Hjortrup et al. PLoS One. .

Abstract

Purpose: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient characteristics and fluid resuscitation volumes in ICU patients with severe sepsis.

Methods: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume and secondary outcome total fluid input administered from 24 hours before randomisation until the end of day 3 post-randomisation. We performed multivariate analyses with hospital and patient baseline characteristics as covariates to assess associations with fluid volumes given.

Results: We included 654 patients who were in the ICU for 3 days and had fluid volumes available. Individual trial sites administered significantly different volumes of fluid resuscitation and total fluid input after adjusting for baseline variables (P<0.001). Increased lactate, higher cardiovascular and renal SOFA subscores, lower respiratory SOFA subscore and surgery were all independently associated with increased fluid resuscitation volumes.

Conclusions: Hospital characteristics adjusted for patient baseline values were associated with differences in fluid resuscitation volumes given in the first 3 days of severe sepsis. The data indicate variations in clinical practice not explained by patient characteristics emphasizing the need for RCTs assessing fluid resuscitation volumes fluid in patients with sepsis.

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Conflict of interest statement

Competing Interests: The authors declare that no competing interests exist. The Dept. of Intensive Care, Rigshospitalet, receives support for research from CSL Behring and Fresenius Kabi. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flowchart of included patients.
Fig 2
Fig 2. Daily fluid volumes presented as median with interquartile range (error bars).
Resuscitation fluid was defined as crystalloids and colloids given from 24 hours prior to randomisation (day 0) until end of day 3 in the 6S trial.
Fig 3
Fig 3. Resuscitation fluid volume (top panel) and total fluid input (bottom panel) by individual trial site with at least 25 randomised patients (n = 542).
Fluid volumes presented as median with interquartile range (error bars). The horizontal dashed line denotes median for all patients. * P-value for trial site in a generalised linear model. Multiple generalised linear model build: Resuscitation fluid ~ Trial site (as a factor) + SAPS II + age + weight + highest lactate + surgery performed prior to randomisation (yes/no) + allocation (HES/Ringer’s acetate) + cardiovascular SOFA subscore + renal SOFA subscore+ liver SOFA subscore + coagulation SOFA subscore + respiratory SOFA subscore.
See this image and copyright information in PMC

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