2025 Southeastern Residency Conference

TITLE: The Variance of Distribution of Fluid Bolus in Patients Diagnosed with Sepsis and Septic Shock within the St. Joseph/Candler Health System
AUTHORS: Saralyn Hardin, Stephen McCall, Caitlyn Johnson
OBJECTIVE: To determine the St. Joseph/Candler Health System’s variation of distribution of fluid bolus volume given within three hours after sepsis or septic shock diagnosis from the standard of care (30mL/kg).
BACKGROUND: Currently the Surviving Sepsis guidelines recommend prompt fluid resuscitation with 30 milliliters per kilogram of crystalloid fluids within the first three hours of care for patients who are either hypotensive or have a lactate level > 4mmol in the absence of randomized control trials to support this recommendation. To our knowledge, there are no trials that include distribution of fluid volumes or categorical incidences manifested from fluid overload such as renal replacement therapy or diuretic administration beyond 72 hours in varying fluid bolus volumes.
METHODS: This was a retrospective, single-centered, observational, chart review of patients who have been admitted to St. Joseph’s or Candler Hospitals and diagnosed with sepsis or septic shock at the time of admission the fluid volume was evaluated with respect to patient ideal body weight in order to determine a health system distribution and variance from guideline recommended resuscitation of 30 mL/kg. Patients were further differentiated into groups based on variance from mean fluid bolus volume using standard Gaussian distribution. Using the health system’s software and a computer-generated list using MedMined™ services to identify patients with this diagnosis between April 1, 2023 and April 1, 2024, patients were reviewed for inclusion in the study.
RESULTS: Three hundred fifty patients were screened for eligibility with a total n=107. The average fluid bolus administered within three hours was found to be 1819.7 milliliters resulting in 29.3 milliliters per kilogram of ideal body weight with the average ideal body weight being 63.4 kilograms. Of the one hundred and seven patients there past medical history’s revealed 18 (17%) congestive heart failure, 21 (21%) chronic kidney disease, 67 (63%) hypertension and 48 (45%) diabetes mellitus. Four of the one hundred and seven patients included experienced an acute heart failure event during hospitalization with one having a past medical history of congestive heart failure. New renal replacement therapy was initiated in three of the one hundred and seven patients with only one patient having a past medical history of chronic kidney disease. There were 19 (18%) of the hundred and seven patients that required new diuretic use during hospitalization. Overall, there is a potential correlation between patients having a past medical history significant for congestive heart failure and fluid bolus given to adverse events. 
CONCLUSION: The overall fluid volume administered to patients during initial fluid resuscitation was comparable close to the guideline’s recommendations with all cause mortality of only eleven percent. However, there were comparable correlations between the total amount of fluid received and adverse events experienced by patients.  Considering the study’s limitations of small sample size, further research with larger, multicenter data should explore potential relationship between fluid bolus given after sepsis or septic shock diagnosis to adverse events.