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Fluid resuscitation is critical in initial treatment of septic shock

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AUSTIN, Texas — Fluid resuscitation is critical in the initial treatment of septic shock, according to a presenter here at the National Kidney Foundation Spring Clinical Meetings.

“It is clear that early volume expansion in patients with distributive shock is necessary to improve survival. The amount of fluid necessary, however, is unclear,” Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF, CCRP, director of the nephrology division and nephrology fellowship program director for Baylor University Medical Center, said.

“Fluid overload, we know, is associated with worse outcomes. Before injudiciously giving an IV fluid bolus, ask yourself how the patient will respond,” he said.

He said fluid balance is the daily difference in intakes and outputs and generally does not include insensible water loss nor does it correlate with body weight. Additionally, fluid balance includes the removal of dialysis fluids and does not consider sodium content. Szerlip said fluid overload is common for patients in the ICU, who can gain 4 L to 6 L of excess body water per day.

To assess volume status, he said lung ultrasound and the assessment of the diameter of the inferior vena cava are useful, however these present limitations. He also recommended the measurement of pulse pressure variation or stroke volume variation after passive leg raises in effort to determine fluid responsiveness.

“[It is] something so simple. Take a patient who is in a semi-recumbent position who pools volume in his lower extremities. Throw his legs up 45. That is like giving him an immediate – like within a minute – a fluid a bolus of 300 mL without you giving the fluid ... It works beautifully,” he said.

Szerlip also said his opinion is that nephrologists should attempt decongestion with diuretics or ultrafiltration after initial resuscitation. – by Kristine Houck, MA, ELS

Reference:

Szerlip HM. Volume overload in AKI: The good, the bad and the ugly. Presented at: National Kidney Foundation Spring Clinical Meetings; April 10-14, 2018; Austin, Texas.

Disclosure: Szerlip reports no relevant financial disclosures.