Tempo de recuperação do choque é determinante do balanço hídrico positivo em pacientes com choque séptico

Abstract

Excess fluids may be harmful in critically ill patients. We aimed to evaluate the cumulative fluid balance during 7 days in patients with septic shock after recovery from shock. Methods: A prospective and observational study in septic shock patients. Patients with MAP ≥ 65 mmHg and lactate < 2.0 mEq/L were included <12 hours after weaning from vasopressors. Daily fluid balance was registered during 7 days after the enrollment. Patients were divided into two groups according to the full cohort's median cumulative fluid balance administered during the period of shock (use of vasopressors) calculated on study day 1: Group 1 ≤ 4.4 L (n = 20) and Group 2 > 4.4 L (n = 20). Results: On study day 1, the cumulative fluid balance was 1.1 [0.6-3.4] L in group 1 and 9.0 [6.7-13.8] L in group 2 (p<0.001). On study day 7, cumulative fluid balance was 8.0 [4.5-12.4] L in group 1 and 14.7 [12.7-20.6] L in group 2 (p<0.001). Time for recovery from shock was predictive of receiving larger volume of fluids (OR: 1.38, 95% CI: 1.08 to 1.75, p = 0.009). After zeroing fluid balance on study day 2, 7 days cumulative fluid balance continues to increase in both groups. Patients in Group 2 had more prolonged length of stay in the ICU and in hospital than patients in Group 1. Conclusion: After recovery from septic shock we notice a huge accumulated fluid balance. A more positive fluid balance was associated with a more prolonged length of stay in the ICU and in the hospital. Time to recover from shock was predictive of receiving larger volumes of fluids.