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Fluid Resuscitation in Septic Shock
Fluid Resuscitation in Septic Shock
Anders Perner
Dept of Intensive Care, Rigshospitalet, University of Copenhagen
Scandinavian Critical Care Trials Group
www.ssai.info/research/SCCTG
Intensive Care Medicine
http://icmjournal.esicm.org/index.html
COIs - Research support from B Braun, Fresenius, CSL Behring
Honoraria from Ferring, LFB
University of
Copenhagen
Triggers?
Which fluid?
How much?
ICM 2013;39:165
CCM 2013;41:580
6S
TRIAL
Triggers?
Which fluid?
How much?
ICM 2013;39:165
CCM 2013;41:580
6S
TRIAL
6S
TRIAL
6S
TRIAL
6S
TRIAL
6S
TRIAL
Baseline characteristics
Group
Starch
Ringers
Numbers
398
400
Age
66 (56-75)
67 (56-76)
4 (1-13)
4 (1-13)
SAPS II
50 (40-60)
51 (39-62)
36%
35%
Shock
84%
84%
6S
TRIAL
Trial fluid
Starch
Ringers
Volume, ml
Volume, ml
Day 1 (14 h)
1500 (1000-1500)
1500 (1000-1550)
Day 2
1000 (300-1500)
1000 (500-1500)
Day 3
500 (0-1000)
425 (0-500)
Day 4
0 (0-500)
0 (0-500)
Day 5
0 (0-500)
0 (0-500)
3000 (1500-5000)
3000 (1800-5500)
Starch increased.
6S
TRIAL
6S
TRIAL
6S
TRIAL
Mortality
RR 1.1 (1.0-1.2)
Starch increased.
Relative risk
increase
1.35
(1.01-1.80)
6S
TRIAL
6S
TRIAL
RR 1.4 (1.1-1.7)
Bleeding outcomes
6S
TRIAL
6S
Time to bleeding
TRIAL
P=0.001
New data
P<0.00000
P<0.001
Primary outcome
90-day mortality
Test of heterogeneity
p=0.004
ICM 2013;39:165
CCM 2013;41:580
Fraud?
Kids
Multivariate analyses
Triggers?
Which fluid?
How much?
by MAP, CVP
and
ScvO2
AJRCCM 2010
AJRCCM 2010
+3L
+1L
+5L
+8L
SAPS II
SOFA
score
Lactate
mmol/l
ScvO2
%
Pressor
dose
Dialysis
Death
day 90
>4.0 L
54 (19)
11 (4)
3.4 (3.3)*
70 (14)
0.25 (0.3)
39%
46%
<4.0 L
54 (22)
11 (4)
2.0 (1.6)
73 (14)
0.18 (0.2)
39%
55%
53 (21)
10 (5)
2.6 (1.7)*
74 (14)
0.16 (0.1)
38%
40%**
<7.5 L
55 (13)
10 (4)
1.9 (1.8)
74 (11)
0.15 (0.1)
33%
62%
SAPS II
SOFA
score
Lactate
mmol/l
ScvO2
%
Pressor
dose
Dialysis
Death
day 90
>4.0 L
54 (19)
11 (4)
3.4 (3.3)*
70 (14)
0.25 (0.3)
39%
46%
<4.0 L
54 (22)
11 (4)
2.0 (1.6)
73 (14)
0.18 (0.2)
39%
55%
53 (21)
10 (5)
2.6 (1.7)*
74 (14)
0.16 (0.1)
38%
40%**
<7.5 L
55 (13)
10 (4)
1.9 (1.8)
74 (11)
0.15 (0.1)
33%
62%
Day 1
6S
SAFE
HES
Ringer
Albumin
Saline
Trial fluid
1.9
2.1
1.3
1.7
Other fluids
2.2
2.0
1.7
1.8
Total, L
4.1
4.1
3.0
3.5
Ratio
0.46
0.51
0.43
0.49
6S
TRISS
TRIAL
TRIAL
anders.perner@regionh.dk