No Clear Association Between Intravenous Fluid Administration and Short-Term Worsening of Left Ventricular Function in Septic Patients with, or without, Heart Failure: A Bayesian Analysis.

BACKGROUND

Volume resuscitation of septic patients must balance harms and benefits. Many emergency physicians are concerned excessive intravenous fluid (IVF) may be harmful, particularly in patients with heart failure (HF).

OBJECTIVE

To compare the association between IVF and left ventricular function over the first 24 h of admission in septic patients with vs. without HF history.

METHODS

Secondary analysis of a prospective, observational cohort of septic adult patients in the emergency department (ED). Patients had an echocardiogram performed at 0, 3, and 24 h after enrollment, with assessment of left ventricular ejection fraction (LVEF), e' velocity, and E/e' ratio. The primary outcome was association of 24-h IVF volume and LV function (modeled as a tensor product interaction between IVF volume and ED Sequential Organ Failure Assessment score) assessed using multilevel Bayesian location-scale models.

RESULTS

Seventy-three patients were recruited. Mean (SD) age was 60.7 (15.6) years; 19% had history of HF. After adjusting for age, biologic sex, HF history, and inferior vena cava collapsibility, each 1-SD increase in IVF volume was associated with small improvements in LV function in patients with or without HF history; the average marginal effect was 2.4% (95% credible interval [CI] -2.6 to 10%) vs. 1.3% (95% CI -1.2 to 4.7%) for LVEF; 1.2 cm/s (95% CI -0.6 to 3.1 cm/s) vs. 0.8 cm/s (95% CI -0.004 to 1.2 cm/s) for e' velocity; -1.72 (95% CI -6.9 to 2.5) vs. -0.92 (95% CI -3.1 to 1.0) for E/e' ratio.

CONCLUSIONS

IVF volume is not unequivocally associated with declining LV function, even in patients with HF. Volume resuscitation should be administered in accordance with clinical need for volume expansion.