Impact of Protocol Based Fluid Resuscitation in Heart Failure Patients Admitted with Sepsis

Introduction Sepsis (severe sepsis and septic shock) with co-existing cardiovascular dysfunction is associated with increased mortality. With concomitant heart failure (HF), clinicians tend to limit fluid resuscitation in sepsis patients due to concerns of pulmonary edema and respiratory failure. We attempted to determine the effect of protocolized fluid resuscitation as per Surviving Sepsis Campaign Guidelines in sepsis patients with HF on clinical outcomes. Methods This was a single center, retrospective study of patients aged ≥18 years, admitted to a critical care unit with sepsis, having a co-diagnosis of systolic HF (EF Results 63 patients received fluids based on clinical judgement (2013), and 54 patients received protocolized fluids (2017). Both groups had similar patient demographics and co-morbidities. In-hospital mortality was higher in 2013, compared to 2017 [49 vs 41%, OR 0.7 (95% CI 0.3,1.5) p=0.36]. Lactic acid ≥4mmol/L was significantly associated with increased mortality [66 vs 36%, OR 3.5 (95% CI 1.6,8.1) p=0.002]. We found no difference in length of stay between the two groups. Patients with coronary artery disease, diabetes mellitus, hypertension, chronic obstructive pulmonary disease and cancer had higher absolute mortality. Conclusion This study demonstrates that there was no difference in-hospital mortality or critical care length of stay between patients receiving protocolized fluid resuscitation and patients receiving fluid resuscitation based on clinical judgement. Further prospective studies in a larger sample of patients are required to support these findings.