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#Hospital Medicine #Internal Medicine #Pediatrics
A new study published in Chest evaluated the efficacy of dynamic measures – stroke volume change during passive leg-raise – to guide resuscitation and improve patient outcomes.
This was a prospective, multicenter, randomized controlled trial, conducted at 13 hospitals in the United States and United Kingdom. Patients who presented to EDs with sepsis, associated hypotension, and anticipated ICU admission were selected. Intervention arm patients were assessed for fluid responsiveness before clinically driven fluid bolus or increase in vasopressors was initiated. While the control arm received usual care.
It was found that in modified intent-to-treat analysis—including 83 intervention and 41 usual care patients—fluid balance at 72 hours or ICU discharge was significantly lower. In addition, fewer patients required renal replacement therapy or mechanical ventilation in the intervention arm, compared to usual care. Meanwhile, in the all-randomized intent-to-treat population, the safety signals did not depict significant differences.
In inference, it was stated that physiologically informed fluid and vasopressor resuscitation with the use of the passive leg raise-induced stroke volume change—for the management of septic shock—is safe. This modality renders lower net fluid balance and reduces the risk of renal and respiratory failure. Moreover, dynamic assessments to guide fluid administration may improve outcomes in patients with septic shock.
Source: Chest. 2020 Oct;158(4):1431-1445. doi: 10.1016/j.chest.2020.04.025.