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Open Access 18-06-2023 | Septic Shock | Original

Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

Authors: Maj-Brit Nørregaard Kjær, Tine Sylvest Meyhoff, Praleene Sivapalan, Anders Granholm, Peter Buhl Hjortrup, Martin Bruun Madsen, Morten Hylander Møller, Ingrid Egerod, Jørn Wetterslev, Theis Lange, Maria Cronhjort, Jon Henrik Laake, Stephan M. Jakob, Marek Nalos, Marlies Ostermann, Doug Gould, Maurizio Cecconi, Manu L. N. G. Malbrain, Christian Ahlstedt, Louise Bendix Kiel, Morten H. Bestle, Lars Nebrich, Thomas Hildebrandt, Lene Russell, Marianne Vang, Michael Lindhart Rasmussen, Christoffer Sølling, Anne Craveiro Brøchner, Mette Krag, Carmen Pfortmueller, Miroslav Kriz, Martin Siegemund, Giovanni Albano, Søren Rosborg Aagaard, Helle Bundgaard, Vera Crone, Sine Wichmann, Bror Johnstad, Yvonne Karin Martin, Philipp Seidel, Johan Mårtensson, Jacob Hollenberg, Mats Wistrand, Abele Donati, Enrico Barbara, Thomas Karvunidis, Alexa Hollinger, Andrea Carsetti, Nuttha Lumlertgul, Eva Joelsson-Alm, Nikolas Lambiris, Tayyba Naz Aslam, Fredrik Femtehjell Friberg, Gitte Kingo Vesterlund, Camilla Bekker Mortensen, Stine Rom Vestergaard, Sidsel Fjordbak Caspersen, Diana Bertelsen Jensen, Morten Borup, Bodil Steen Rasmussen, Anders Perner

Published in: Intensive Care Medicine | Issue 7/2023

Abstract

Purpose

To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial.

Methods

We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function.

Results

Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) − 4.8 to 7.8]. Mean differences were 0.00 (99% CI − 0.06 to 0.05) for EQ-5D-5L index values, − 0.65 for EQ VAS (− 5.40 to 4.08), and − 0.14 for Mini MoCA (− 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups.

Conclusions

Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out.

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Title: Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock
Authors: Maj-Brit Nørregaard Kjær
Tine Sylvest Meyhoff
Praleene Sivapalan
Anders Granholm
Peter Buhl Hjortrup
Martin Bruun Madsen
Morten Hylander Møller
Ingrid Egerod
Jørn Wetterslev
Theis Lange
Maria Cronhjort
Jon Henrik Laake
Stephan M. Jakob
Marek Nalos
Marlies Ostermann
Doug Gould
Maurizio Cecconi
Manu L. N. G. Malbrain
Christian Ahlstedt
Louise Bendix Kiel
Morten H. Bestle
Lars Nebrich
Thomas Hildebrandt
Lene Russell
Marianne Vang
Michael Lindhart Rasmussen
Christoffer Sølling
Anne Craveiro Brøchner
Mette Krag
Carmen Pfortmueller
Miroslav Kriz
Martin Siegemund
Giovanni Albano
Søren Rosborg Aagaard
Helle Bundgaard
Vera Crone
Sine Wichmann
Bror Johnstad
Yvonne Karin Martin
Philipp Seidel
Johan Mårtensson
Jacob Hollenberg
Mats Wistrand
Abele Donati
Enrico Barbara
Thomas Karvunidis
Alexa Hollinger
Andrea Carsetti
Nuttha Lumlertgul
Eva Joelsson-Alm
Nikolas Lambiris
Tayyba Naz Aslam
Fredrik Femtehjell Friberg
Gitte Kingo Vesterlund
Camilla Bekker Mortensen
Stine Rom Vestergaard
Sidsel Fjordbak Caspersen
Diana Bertelsen Jensen
Morten Borup
Bodil Steen Rasmussen
Anders Perner
Publication date: 18-06-2023
Publisher: Springer Berlin Heidelberg
Keywords: Septic Shock
Septicemia
Septicemia
Published in: Intensive Care Medicine / Issue 7/2023
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-023-07114-8

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Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

Abstract

Purpose

Methods

Results

Conclusions

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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