Comparison of fluid resuscitation weight-based dosing strategies in obese patients with severe sepsis

Objective: This study aims to compare the composite outcome of progression to septic shock between 30 mL/kg/ ideal body weight (IBW) versus 30 mL/kg/non-IBW fluid resuscitation dosing strategies in obese patients with severe sepsis. Methods: We retrospectively evaluated obese patients admitted to an academic tertiary care center for themanagement of severe sepsis. Patients were included if they had a fluid bolus order placed using the sepsis order set between Oct 2018 and Sept 2019. The primary objective was the composite of progression to septic shock, defined as either persistent hypotension within 3 h after the conclusion of the 30 mL/kg fluid bolus administration or the initiation of vasopressor(s) within 6 h of the bolus administration. Results: Of 72 included patients, 49 (68%) were resuscitated using an IBW-based and 23 (32%) using a non-IBW-based dosing strategy. There were similar rates of progression to septic shock in the IBW and non-IBW groups (18% vs. 26%; p = 0.54). Median ICU and hospital LOS in the IBWgroup versus non-IBWgroup were (0 [IQR 0] vs. 0 [IQR 0 to 4] days; p = 0.13) and (6 [IQR 3 to 10] vs. 8 [ IQR 5 to 12] days; p = 0.07), respectively. Inhospital mortality rates were similar between the groups. Conclusions: Our study results suggest that in obese septic patients, fluid administration using an IBW-dosing strategy did not affect the progression to septic shock. Published by Elsevier Inc.

Automated summary

This study compared the outcomes of using different fluid resuscitation dosing strategies in obese patients with severe sepsis, showing that there were similar rates of progression to septic shock between the IBW and non-IBW groups. Additionally, the length of hospital stay and mortality rates were not significantly different between the two groups.