SUMMARY: This study investigated the clinical characteristics of, and outcomes and risk factors for hospital mortality of 390 patients admitted with severe sepsis or septic shock in an intensive care unit (ICU). Prospectively collected data from patients collected between 1 July 2004 and 30 June 2006 were analysed. Overall hospital mortality was 49·7% and comorbidities were found in 40·3% of patients, the most common of which was haematological malignancy. The respiratory tract was the most common site of infection (50%). Hospital-acquired infections accounted for 55·6% of patients with Gram-negative bacteria predominant (68%). Multivariate analysis showed that acute respiratory distress syndrome, pulmonary artery catheter placement, comorbidities, hospital-acquired infection, APACHE II score and maximum LOD score, were independent risk factors for hospital mortality. In conclusion, severe sepsis and septic shock are common causes of ICU admission. Patients with risk factors for increased mortality should be carefully monitored and aggressive treatment administered.

Objectives The aim of this study was to assess and compare the ability of the automatically and continuously measured stroke volume variation (SVV) obtained by FloTrac/Vigileo, and pulse pressure variation (PPV) measured by an IntelliVue MP monitor, to predict fluid responsiveness in mechanically ventilated septic shock patients. Method We conducted a prospective study on 42 septic shock patients. SVV, PPV and other haemodynamic data were recorded before and after fluid administration of 500 ml of 6% hydroxyethyl starch. Responders were defined as patients with an increase in stroke volume index of at least 15% after fluid loading. Results Twenty-four (57.1%) patients were classified as fluid responders. The baseline SVV correlated with the baseline PPV (r = 0.96, P < 0.001). SVV and PPV were significantly higher in responders than in nonresponders (15.5 ± 4.5 vs. 8.2 ± 3.3% and 16.4 ± 5.2 vs. 8.3 ± 3.5, respectively, P < 0.001 for both). There was no difference between the area under the receiver operating characteristic curves of SVV [0.92, 95% confidence interval 0.832–1.00] and PPV (0.916, 95% confidence interval 0.829–1.00). The optimal threshold values in predicting fluid responsiveness were 10% for SVV (sensitivity 91.7% and specificity 83.3%) and 12% for PPV (sensitivity 83.3% and specificity 83.3%). Our results were independent of the site of arterial catheterisation. Conclusion The SVV, obtained by FloTrac/Vigileo, and the automated PPV, obtained by the IntelliVue MP monitor, showed comparable performance in terms of predicting fluid responsiveness in passively ventilated septic shock patients, with a regular cardiac rhythm and a tidal volume not less than 8 ml kg⁻¹.

Background: Fluid management is important in critically patients. The aim of this study was to determine the relationship between fluid balance and adverse outcomes of septic shock. Methods: A retrospective study was conducted in the medical Intensive Care Unit (ICU) of a tertiary university hospital in Thailand, over a 7-year period. Results: A total of 1048 patients with an ICU mortality rate of 47% were enrolled. The median cumulative fluid intake at 24, 48, and 72 h from septic shock onset were 4.2, 7.7, and 10.5 L, respectively. Nonsurvivors had a significantly higher median cumulative fluid intake at 24, 48, and 72 h (4.6 vs. 3.9 L, 8.2 vs. 7.1 L, and 11.4 vs. 9.9 L, respectively, P < 0.001 for all). Nonsurvivors also had a significantly higher cumulative and mean fluid balance within 72 h (5.4 vs. 4.4 L and 2.8 vs. 1.6 L, P < 0.001 for both). In multivariate logistic regression analysis, mean fluid balance quartile within 72 h, was independently associated with an increase in ICU and hospital mortality. Quartile 3 and 4 have statistically significant increases in mortality compared with quartile 1 (odds ratio [95% confidence interval] 3.04 [1.9-4.48] and 4.16 [2.49-6.95] for ICU mortality and 2.75 [1.74-4.36] and 3.16 [1.87-5.35] for hospital mortality, respectively, P < 0.001 for all). In addition, the higher amount of mean fluid balance was associated with prolonged ICU stays. Conclusions: Positive fluid balance over 3 days is associated with increased ICU and hospital mortality along with prolonged ICU stays in septic shock patients.