PMID- 32297028 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2110-5820 (Print) IS - 2110-5820 (Electronic) IS - 2110-5820 (Linking) VI - 10 IP - 1 DP - 2020 Apr 15 TI - Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina. PG - 40 LID - 10.1186/s13613-020-00659-7 [doi] LID - 40 AB - BACKGROUND: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality. METHODS: Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis. RESULTS: Initially, 584 of 787 patients (74%) had mean arterial pressure (MAP) < 65 mm Hg and/or signs of hypoperfusion and received 30 mL/kg of fluids, mostly normal saline (53%) and Ringer lactate (35%). Vasopressors and/or inotropes were administered in 514 (65%) patients, mainly norepinephrine (100%) and dobutamine (9%); in 22%, vasopressors were administered before ending the fluid load. After this, 413 patients (53%) presented persisting or recurrent hypotension and/or hypoperfusion, which prompted administration of additional fluid, based on: lactate levels (66%), urine output (62%), heart rate (54%), central venous O(2) saturation (39%), central venous-arterial PCO(2) difference (38%), MAP (31%), dynamic tests of fluid responsiveness (30%), capillary-refill time (28%), mottling (26%), central venous pressure (24%), cardiac index (13%) and/or pulmonary wedge pressure (3%). Independent predictors of mortality were SOFA and Charlson scores, lactate, requirement of mechanical ventilation, and utilization of dynamic tests of fluid responsiveness. CONCLUSIONS: In this prospective observational study assessing the characteristics of resuscitation of septic patients in Argentina, a LMIC, the prevalent use of initial fluid bolus with normal saline and Ringer lactate and the use of norepinephrine as the most frequent vasopressor, reflect current worldwide practices. After initial resuscitation with 30 mL/kg of fluids and vasopressors, 413 patients developed persistent or recurrent hypoperfusion, which required further volume expansion. In this setting, the assessment of fluid responsiveness with dynamic tests to guide fluid resuscitation was independently associated with decreased mortality. FAU - Dubin, Arnaldo AU - Dubin A AD - Servicio de Terapia Intensiva, Sanatorio Otamendi, Azcuenaga 870, C1115 AAB, Buenos Aires, Argentina. arnaldodubin@gmail.com. FAU - Loudet, Cecilia AU - Loudet C AD - Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina. FAU - Kanoore Edul, Vanina S AU - Kanoore Edul VS AD - Hospital Juan A Fernandez, Buenos Aires, Argentina. FAU - Osatnik, Javier AU - Osatnik J AD - Hospital Aleman, Buenos Aires, Argentina. FAU - Rios, Fernando AU - Rios F AD - Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina. FAU - Vasquez, Daniela AU - Vasquez D AD - Sanatorio Anchorena, Buenos Aires, Argentina. FAU - Pozo, Mario AU - Pozo M AD - Clinica Bazterrica, Buenos Aires, Argentina. FAU - Lattanzio, Bernardo AU - Lattanzio B AD - Clinica Santa Isabel, Buenos Aires, Argentina. FAU - Palizas, Fernando AU - Palizas F AD - Clinica Bazterrica, Buenos Aires, Argentina. FAU - Klein, Francisco AU - Klein F AD - Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina. FAU - Piezny, Damian AU - Piezny D AD - Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina. FAU - Rubatto Birri, Paolo N AU - Rubatto Birri PN AD - Servicio de Terapia Intensiva, Sanatorio Otamendi, Azcuenaga 870, C1115 AAB, Buenos Aires, Argentina. FAU - Tuhay, Graciela AU - Tuhay G AD - Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina. FAU - Garcia, Analia AU - Garcia A AD - Hospital Misericordia, Cordoba, Argentina. FAU - Santamaria, Analia AU - Santamaria A AD - Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina. FAU - Zakalik, Graciela AU - Zakalik G AD - Hospital Lagomaggiore, Mendoza, Argentina. FAU - Gonzalez, Cecilia AU - Gonzalez C AD - Sanatorio Parque, Rosario, Santa Fe, Argentina. FAU - Estenssoro, Elisa AU - Estenssoro E AD - Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina. CN - investigators of the SATISEPSIS group LA - eng GR - 2014/Ministerio de Salud de la Argentina/ PT - Journal Article DEP - 20200415 PL - Germany TA - Ann Intensive Care JT - Annals of intensive care JID - 101562873 PMC - PMC7158970 OTO - NOTNLM OT - Dynamic tests OT - Fluid responsiveness OT - Hypoperfusion OT - Sepsis OT - Vasopressors COIS- The authors declare that they have no competing interests. FIR - Enrico, Carolina IR - Enrico C FIR - Romitelli, Mariel IR - Romitelli M FIR - Garcia, Mariel Ayelen IR - Garcia MA FIR - Celia, Jose IR - Celia J FIR - Machuca, Leandro IR - Machuca L FIR - Palizas, Fernando Jr IR - Palizas F Jr FIR - Pozo, Mario IR - Pozo M FIR - Lattanzio, Bernardo IR - Lattanzio B FIR - Valgolio, Emanuel IR - Valgolio E FIR - Kenar, Mario IR - Kenar M FIR - Sosa, Carlos IR - Sosa C FIR - Sarquis, Sergio IR - Sarquis S FIR - Tuhay, Graciela IR - Tuhay G FIR - Klein, Francisco IR - Klein F FIR - Sosa, Ariel IR - Sosa A FIR - Ivulich, Daniel IR - Ivulich D FIR - Bianchi, Luciana IR - Bianchi L FIR - Correger, Enrique Ruben IR - Correger ER FIR - Groer, Carla IR - Groer C FIR - Arrosagaray, Ma Victoria IR - Arrosagaray MV FIR - Cueto, Graciela IR - Cueto G FIR - Cozzani, Carlos IR - Cozzani C FIR - Badariotti, Gustavo IR - Badariotti G FIR - de Diego, Bernardo IR - de Diego B FIR - Vasquez, Daniela IR - Vasquez D FIR - Plotnikov, Gustavo IR - Plotnikov G FIR - Santa Maria, Analia IR - Santa Maria A FIR - Bertes, Mariana IR - Bertes M FIR - Gomez, Alejandro IR - Gomez A FIR - Santagiuliana, Maria Soledad IR - Santagiuliana MS FIR - Tavela, Margarita IR - Tavela M FIR - Bachetti, Pierina IR - Bachetti P FIR - Irrazabal, Celica IR - Irrazabal C FIR - Risso Vazquez, Alejandro IR - Risso Vazquez A FIR - Rubatto Birri, Paolo Nahuel IR - Rubatto Birri PN FIR - Olarte, Gabriel IR - Olarte G FIR - Cannatelli, Veronica Marcela IR - Cannatelli VM FIR - Diaz, Anatilde IR - Diaz A FIR - Garcia, Analia IR - Garcia A FIR - Minoldo, Estefania IR - Minoldo E FIR - Galletti, Cayetano IR - Galletti C FIR - Payer, Esteban IR - Payer E FIR - Avilez, Marcelo IR - Avilez M FIR - Lazzeri, Silvio Ernesto IR - Lazzeri SE FIR - Huespe, Luis A IR - Huespe LA FIR - Parra, Lorena de Los Angeles IR - Parra LLA FIR - Kurban, Fernando IR - Kurban F FIR - Pellegrini, Carlos Anibal IR - Pellegrini CA FIR - Martin, Adrian Alfredo IR - Martin AA FIR - Zakalik, Graciela IR - Zakalik G FIR - Sanchez, Magali IR - Sanchez M FIR - Barreto, Natalia IR - Barreto N FIR - Carreras, Alfredo Elias IR - Carreras AE FIR - Bastias, Johana IR - Bastias J FIR - Ivacachi, Julian IR - Ivacachi J FIR - Campassi, Maria Luz IR - Campassi ML FIR - Repetto, Fabio German IR - Repetto FG FIR - Saenz, Maria Gabriela IR - Saenz MG FIR - Marchena, Cecilia IR - Marchena C FIR - Marino, Maria Rosa IR - Marino MR FIR - Ezcurra, Gerardo IR - Ezcurra G FIR - Caravaggio, Sebastian IR - Caravaggio S FIR - Garcia, Maria de Los Angeles IR - Garcia MLA FIR - Mazzola, Ana Maria IR - Mazzola AM FIR - Piernatei, Analia IR - Piernatei A FIR - Molinas, Estela IR - Molinas E FIR - Iadanza, Mauro IR - Iadanza M FIR - Traba, Mario Alejandro IR - Traba MA FIR - Bacci, Leda Fiorella IR - Bacci LF FIR - Fernandez, Adriana IR - Fernandez A FIR - Piezny, Damian IR - Piezny D FIR - Arias, Constanza IR - Arias C FIR - Chaparro, Gustavo IR - Chaparro G FIR - Lopez, Graciela Celeste IR - Lopez GC FIR - Fernandez, Agustin IR - Fernandez A FIR - Reyes Najera, Catalina IR - Reyes Najera C FIR - Baldiviezo, Adriana IR - Baldiviezo A FIR - Flores, Alejandra IR - Flores A FIR - Risso Vazquez, Alejandro IR - Risso Vazquez A FIR - Moyano, Irma IR - Moyano I FIR - Quinteros, Monica IR - Quinteros M FIR - Budrovich, Laura IR - Budrovich L FIR - Corzo, Lilen IR - Corzo L FIR - Amieva, Sebastian Andres IR - Amieva SA FIR - Re, Melisa IR - Re M FIR - Rocchetti, Nicolas IR - Rocchetti N FIR - Pendino, Juan Carlos IR - Pendino JC FIR - Bettini, Lisandro IR - Bettini L FIR - Talamonti, Lionel IR - Talamonti L FIR - Izaguirre, Gustavo IR - Izaguirre G FIR - Schmukler, German IR - Schmukler G FIR - Sabbag, Ignacio IR - Sabbag I FIR - Diez, Tomas F IR - Diez TF FIR - Bergallo, Laura IR - Bergallo L FIR - Gonzalez, Cecilia IR - Gonzalez C FIR - Lovesio, Carlos IR - Lovesio C FIR - Duarte, Daniel IR - Duarte D FIR - Nicastro, Romina IR - Nicastro R FIR - Bertoletti, Fernando IR - Bertoletti F FIR - Milioto, Esteban IR - Milioto E EDAT- 2020/04/17 06:00 MHDA- 2020/04/17 06:01 PMCR- 2020/04/15 CRDT- 2020/04/17 06:00 PHST- 2020/01/28 00:00 [received] PHST- 2020/04/04 00:00 [accepted] PHST- 2020/04/17 06:00 [entrez] PHST- 2020/04/17 06:00 [pubmed] PHST- 2020/04/17 06:01 [medline] PHST- 2020/04/15 00:00 [pmc-release] AID - 10.1186/s13613-020-00659-7 [pii] AID - 659 [pii] AID - 10.1186/s13613-020-00659-7 [doi] PST - epublish SO - Ann Intensive Care. 2020 Apr 15;10(1):40. doi: 10.1186/s13613-020-00659-7.