Do septic patients with reduced left ventricular ejection fraction require a low-volume resuscitative strategy?

Area of Science:

• Critical Care Medicine
• Cardiology
• Emergency Medicine

Background:

• Clinicians hesitate to administer 30 cc/kg of intravenous fluids (IVF) to septic patients with reduced left-ventricular ejection fraction (rLVEF) due to concerns of volume overload.
• Previous studies relied on heart failure history, not presenting LVEF, potentially confounding the relationship between rLVEF, IVF, and outcomes.

Purpose of the Study:

• To evaluate the association between IVF volume and clinical outcomes in septic patients with and without rLVEF.
• To determine if rLVEF impacts the safety and efficacy of IVF administration in sepsis.

Main Methods:

• Prospective observational study in an urban Emergency Department (ED).
• Included adult patients with suspected sepsis (infection + SBP <90 mmHg or lactate >2 mmol/L).
• Left-ventricular ejection fraction (LVEF) assessed by ED echocardiogram before >1 L IVF administration.

Main Results:

• 73 patients enrolled; 33 had rLVEF (<40%).
• Patients with rLVEF were older, had higher initial lactate, and more ICU admissions and vasopressor use.
• Similar 3-hour IVF volumes between groups (2.2 L vs 2.0 L); rLVEF patients more likely to reach 30 cc/kg (61% vs 45%).
• Hospital, ICU, and ventilator days were comparable between groups.

Conclusions:

• Septic patients with rLVEF received similar IVF volumes as those without rLVEF.
• No increased adverse outcomes related to volume overload were observed in the rLVEF group.
• Limiting IVF in septic patients with rLVEF may not be necessary, warranting further validation.