(1492) Trends in Emergency Department Fluid Resuscitation in Patients With Sepsis

Introduction: The Surviving Sepsis Campaign (SSC) recommends 30 ml/kg of intravenous (IV) fluid be administered within 3 hours to patients presenting with sepsis induced hypotension or septic shock. This recommendation does not apply to patients with severe sepsis without hypotension or simple sepsis. We suspect that emphasis on early fluid administration in higher severity sepsis patients has led to changes in provider practice patterns with significant fluid volumes being given without clear guideline indication. Our study was to review fluid administration trends in patients with sepsis during initial emergency department (ED) resuscitation in a community hospital.

Methods: This single community ED retrospective chart review identified patients between 2017-2021 diagnosed with sepsis, severe sepsis, or septic shock using pre-defined ICD-10 diagnoses. Exclusion criteria were concurrent diagnosis of COVID-19 or acute gastrointestinal bleeding. The primary outcome measure was the percentage of patients within each sepsis category that received 2 - 30 mL/kg within 6 hours of presentation. A secondary analysis will evaluate complications related to fluid therapy.

Results: From 2017-2021, 1962 patients were diagnosed with sepsis, severe sepsis, and septic shock. Of those diagnosed with septic shock, 71.6% received a 30 mL/kg within 6 hours of presentation (95% CI 65-78.2).By comparison, the same fluid therapy was also given to 69.7% of patients with severe sepsis with- hypotension (95% CI 54.1-85.3), 67.4% with severe sepsis without hypotension (95% CI 58.5-76.3), and 57.5% with simple sepsis (95% CI 54.6-60.4). On average, patients in septic shock received 41.4 mL/kg, patients in severe sepsis with hypotension received 42.4 mL/kg, patients with severe sepsis without hypotension received 31.6 ml/kg, and patients with simple sepsis received 33.6 mL/kg.

Conclusions: Large volume fluid resuscitation appears to have become common in patients with suspected sepsis regardless of sepsis severity. The SSC recommendation for fluid therapy in patients with septic shock or severe sepsis with hypotension was administered to more than half of sepsis patients without clear guideline. Further studies are needed to determine if aggressive fluid therapy in less severe sepsis patients leads to adverse outcomes.