Impact of fluid resuscitation in pulmonary hypertension with sepsis on respiratory support

Document Type

Conference Proceeding

Publication Date

1-1-2022

Publication Title

Crit Care Med

Abstract

INTRODUCTION/HYPYOTHESIS: Current guidelines recommend an intravenous 30 mL/kg crystalloid fluid bolus as initial sepsis management. Patients with pulmonary hypertension (PH) may not tolerate recommended resuscitation volumes due to increased pulmonary vascular resistance and right ventricular dysfunction. The purpose of this study was to compare guideline-based sepsis fluid resuscitation management and the subsequent need for respiratory support escalation in patients with PH to patients without PH. METHODS: This was an IRB-approved retrospective, cohort study of patients hospitalized at an academic medical center from November 2013 to December 2019 diagnosed with sepsis based on the Sepsis-2 definition. Patients were separated into two groups based on a previous diagnosis of PH or no previous diagnosis of PH. The primary outcome was prevalence of respiratory support escalation within 72 hours from time zero. Time zero was defined as presence of ≥ 2 SIRS criteria plus suspected or confirmed infection. Respiratory support escalation included high-flow nasal cannula, bilevel positive airway pressure, or intubation. Secondary outcomes included total fluid volumes at varying time points, vasopressor initiation, and lactate clearance. Data was analyzed using chi-square for categorical data and Mann-Whitney U for continuous data. Multivariable regression assessed for predictors of respiratory support escalation. RESULTS: A total of 104 patients were included with 52 in the PH group and 52 in the non-PH group. Patients with PH were more likely to require escalation of respiratory support compared to the non-PH group (32.7 vs 11.5%; p=0.009). Less patients with PH received 30 mL/kg of crystalloid within 6 hours of time zero compared to the non-PH group (3.8 vs 42.3%; p< 0.001). Vasopressor initiation was more common in the PH group (40.4 vs 19.2%; p=0.018). No difference was found in time to lactate clearance. PH diagnosis was the only independent predictor of respiratory support escalation. CONCLUSIONS: During initial sepsis management when compared to patients without PH, patients with PH had increased instances of respiratory support escalation within the first three days of sepsis time zero. Future research is warranted to guide sepsis fluid resuscitation within the PH population.

Volume

50

Issue

1 SUPPL

First Page

710

Last Page

710

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