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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

C. Ahlstedt, P. Sivapalan, M. Kriz, G. Jacobson, T. Sylvest Meyhoff, B. Skov Kaas-Hansen, M. Holm, J. Hollenberg, M. Nalos, O. Rooijackers, M. Hylander Møller, M. Cronhjort, A. Perner, J. Grip

. 2024 ; 50 (5) : 678-686. [pub] 20240410

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, randomizované kontrolované studie, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc24014086

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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$a 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 / $c C. Ahlstedt, P. Sivapalan, M. Kriz, G. Jacobson, T. Sylvest Meyhoff, B. Skov Kaas-Hansen, M. Holm, J. Hollenberg, M. Nalos, O. Rooijackers, M. Hylander Møller, M. Cronhjort, A. Perner, J. Grip
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$a 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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$a Sivapalan, Praleene $u Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $u Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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$a Kriz, Miroslav $u Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
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$a Jacobson, Gustaf $u Department of Perioperative Medicine and Intensive Care (PMI), K32, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
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$a Sylvest Meyhoff, Tine $u Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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$a Skov Kaas-Hansen, Benjamin $u Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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$a Holm, Manne $u Department of Perioperative Medicine and Intensive Care (PMI), K32, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
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$a Hollenberg, Jacob $u Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden $u Medical Intensive Care Unit, Södersjukhuset, Stockholm, Sweden
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$a Nalos, Marek $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $u Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic $u Department of Anaesthesia, Perioperative and Intensive Care Medicine, Masaryk Hospital, Jan Evangelista Purkynӗ University, Ústi Nad Labem, Czech Republic
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$a Rooijackers, Olav $u Department of Perioperative Medicine and Intensive Care (PMI), K32, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden $u Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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$a Hylander Møller, Morten $u Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $u Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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$a Cronhjort, Maria $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $u Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden $u Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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$a Perner, Anders $u Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark $u Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark $u Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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$a Grip, Jonathan $u Department of Perioperative Medicine and Intensive Care (PMI), K32, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden $u Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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