The Relationship Between Fluid Management And Prognosis In The Septic Patients

Objective: Fluid therapy is an important part of the treatment of sepsis,but the relationship between patient's fluid balance and the outcome of sepsis are not clear.This study investigated the relationship between fluid management and prognosis in patients with sepsis by retrospectively comparing the relationship between fluid volume and survival in patients with sepsis and the effect of different fluid balances on prognosis.Methods: Retrospective cohort study was performed on 370 patients with sepsis and septic shock who met the inclusion criteria at the Emergency Intensive Care Unit(EICU)of the Third Hospital of Hebei Medical University.Patients were grouped according to the 28-day mortality and statistically analyze the daily intake and output,liquid equilibrium and cumulative liquid equilibrium within 5 consecutive days.According to the average daily liquid equilibrium of the 5th day,it was divided into three groups A,B,and C(group A?0 ml/d,group B 0 ? 500 ml/d,and group C?-500 ml/d),APACHE II score,SOFA score within 24 hours upon EICU admission,use of broad-spectrum antibiotics and vasoactive drugs were observed.At the same time,the complications,fatality rates and use of mechanical ventilation and CRRT within 28 days after treatment were compared to analyze the relationship between different fluid management methods and prognosis in patients.Results: Compared with the survival group,the patients in the death group had more daily liquid intake and less output.The daily liquid equilibrium and cumulative liquid equilibrium of the patients in the two groups were significantly different on the 3rd to 5th days(P < 0.01).Logistic regression analysis showed that patients with sepsis and septic shock who had a significant decrease in liquid equilibrium after the third day of admission,suggesting a better prognosis(P < 0.01).The A,B,and C groups had statistically significant differences in APACHE II scores,SOFA scores within 24 hours of EICU admission,use of vasoactive drugs within 1 hour,and complications,mortality,mechanical ventilation,and the CRRT usage within 28 days of treatment(P < 0.05).Conclusions: Persistent positive liquid equilibrium is associated with complications and mortality in patients with sepsis and septic shock;a significant decrease in liquid equilibrium after 3 days of hospitalization for septic patients will indicate a better prognosis;achieving negative liquid equilibrium as soon as possible after the perfusion condition of vital organs are satisfied will reduce the mechanical ventilation and the CRRT usage,complications and mortality of septic patients.