Fluid Therapy in Shock Program

Fluid resuscitation is a mainstay of treatment for most patients with shock. In conjunction with antibiotics, fluids and hemodynamic support have been shown to be an essential component of sepsis treatment, and early fluids were administrated as part of both the standard and interventional arms of the large trials of early goal-directed therapy in sepsis. While clinical guidelines support the use of 30 cc/kg as initial resuscitation, there appears to be substantial variation in practice between clinicians for the amount of fluids delivered.

While adequate volume resuscitation is an important part of treatment paradigms (to allow for adequate preload and cardiac output), excessive volume resuscitation appears to be associated with organ failure and worse clinical outcomes. An important part of this variation appears to be the decision of how to determine the amount of fluids prescribed. There are many studies that show that dynamic measures such as the passive leg raise or non-invasive measures of stroke volume variability are good predictors of response to cardiac output to fluid challenges, but there are few studies to predict whether important clinical outcomes are affected by the use of these dynamic measures.

We are planning a multicenter observational cohort across a broad range of hospitals including patients in the emergency department, ICU, and non-ICU areas of the hospital to determine the variability in fluid resuscitation in shock and the modalities used to determine the amount of fluids to administer. This study will be conducted through the Discovery network and will form the basis for a later interventional trial. Contact Jon Sevransky at jsevran@emory.edu for more information.