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Open Access 10-04-2024 | Septic Shock | Original

Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial

Authors: Christian Ahlstedt, Praleene Sivapalan, Miroslav Kriz, Gustaf Jacobson, Tine Sylvest Meyhoff, Benjamin Skov Kaas-Hansen, Manne Holm, Jacob Hollenberg, Marek Nalos, Olav Rooijackers, Morten Hylander Møller, Maria Cronhjort, Anders Perner, Jonathan Grip

Published in: Intensive Care Medicine | Issue 5/2024

Abstract

Purpose

The aim of this study was to examine the effects of intravenous (IV) fluid restriction on time to resolution of hyperlactatemia in septic shock. Hyperlactatemia in sepsis is associated with worse outcome. Sepsis guidelines suggest targeting lactate clearance to guide fluid therapy despite the complexity of hyperlactatemia and the potential harm of fluid overload.

Methods

We conducted a post hoc analysis of serial plasma lactate concentrations in a sub-cohort of 777 patients from the international multicenter clinical CLASSIC trial (restriction of intravenous fluids in intensive care unit (ICU) patients with septic shock). Adult ICU patients with septic shock had been randomized to restrictive (n = 385) or standard (n = 392) intravenous fluid therapy. The primary outcome, time to resolution of hyperlactatemia, was analyzed with a competing-risks regression model. Death and discharge were competing outcomes, and administrative censoring was imposed 72 h after randomization if hyperlactatemia persisted. The regression analysis was adjusted for the same stratification variables and covariates as in the original CLASSIC trial analysis.

Results

The hazard ratios (HRs) for the cumulative probability of resolution of hyperlactatemia, in the restrictive vs the standard group, in the unadjusted analysis, with time split, were 0.94 (confidence interval (CI) 0.78–1.14) at day 1 and 1.21 (0.89–1.65) at day 2–3. The adjusted analyses were consistent with the unadjusted results.

Conclusion

In this post hoc retrospective analysis of a multicenter randomized controlled trial (RCT), a restrictive intravenous fluid strategy did not seem to affect the time to resolution of hyperlactatemia in adult ICU patients with septic shock.

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Title: Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial
Authors: Christian Ahlstedt
Praleene Sivapalan
Miroslav Kriz
Gustaf Jacobson
Tine Sylvest Meyhoff
Benjamin Skov Kaas-Hansen
Manne Holm
Jacob Hollenberg
Marek Nalos
Olav Rooijackers
Morten Hylander Møller
Maria Cronhjort
Anders Perner
Jonathan Grip
Publication date: 10-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Septic Shock
Septicemia
Septicemia
Published in: Intensive Care Medicine / Issue 5/2024
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-024-07385-9

Keynote webinar | Spotlight on medication adherence

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Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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