Fluid Balance in the ICU - Interventions to Minimize Fluids in Patients With Septic Shock
Septic Shock, Fluid Therapy, Hypotension
About this trial
This is an interventional treatment trial for Septic Shock
Eligibility Criteria
Inclusion Criteria:
- Adult patient with septic shock as the primary cause of hypotension
- Requiring vasopressors for 12 hours after adequate fluid resuscitation and at the time of enrollment
Exclusion Criteria:
- Patients with a history of end-stage renal disease requiring outpatient dialysis
- Patients whose goals of care are consistent with comfort measures only
- Pregnant patients
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Fluid minimization group
Usual care group
Patients in the fluid minimization arm will have daily fluid intake and output, baseline central venous pressure, mean arterial pressure, central venous oxygen saturation, pulse pressure variation, and inferior vena cava diameters during inspiration and expiration recorded by a dedicated research fellow. Patients who are intubated will also have corrected flow time, stroke volume, cardiac output, and cardiac index recorded via CardioQ. A fluid challenge in the form of a leg raise or infusion of 250 mL of crystalloid over 5 minutes will then be performed and the parameters repeated. The patient will be judged to be fluid responsive or nonresponsive based on the changes in the parameters. Fluid nonresponsive patients will receive the intervention of the fluid minimization protocol by concentrating continuous infusions, discontinuing maintenance fluids, and minimizing carrier fluids. Diuretics and/or ultrafiltration will be utilized to maintain an even to negative fluid balance.
Patients in the usual care arm will have daily fluid intake and output, baseline central venous pressure, mean arterial pressure, central venous oxygen saturation, pulse pressure variation, and inferior vena cava diameters during inspiration and expiration recorded by a dedicated research fellow. Patients who are intubated will also have corrected flow time, stroke volume, cardiac output, and cardiac index recorded via CardioQ.