Initial fluid resuscitation following adjusted body weight dosing is associated with improved mortality in obese patients with suspected septic shock

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Abstract

Objective:

The optimal initial fluid resuscitation strategy for obese patients with septic shock is unknown. We evaluated fluid resuscitation strategies across BMI groups.

Materials and methods:

Retrospective analysis of 4157 patients in a multicenter activation pathway for treatment of septic shock between 2014 and 2016.

Results:

1293 (31.3%) patients were obese (BMI ≥ 30). Overall, higher BMI was associated with lower mortality, however this survival advantage was eliminated in adjusted analyses. Patients with higher BMI received significantly less fluid per kilogram at 3 h than did patients with lower BMI (p ≤0.001). In obese patients, fluid given at 3 h mimicked a dosing strategy based on actual body weight (ABW) in 780 (72.2%), adjusted body weight (AdjBW) in 95 (8.8%), and ideal body weight (IBW) in 205 (19.0%). After adjusting for condition- and treatment-related variables, dosing based on AdjBW was associated with improved mortality compared to ABW (OR 0.45; 95% CI [0.19, 1.07]) and IBW (OR 0.29; 95% CI [0.11,0.74]).

Conclusions:

Using AdjBW to calculate initial fluid resuscitation volume for obese patients with suspected shock may improve outcomes compared to other weight-based dosing strategies. The optimal fluid dosing strategy for obese patients should be a focus of future prospective research.

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