(1662) The Impact of Volume Resuscitation on the Outcomes of Patients With Heart Failure and Septic Shock

Introduction: Fluid resuscitation is a critical intervention in sepsis management, yet there is a scarcity of data concerning its efficacy in patients with pre-existing heart failure (HF). This study aimed to investigate how fluid resuscitation influences outcomes in patients with prior diagnosis of heart failure with reduced left ventricular ejection fraction < 50% (LVEF).

Methods: This multicenter, retrospective, cohort study was conducted at medical ICUs of Good Samaritan Hospital and Bethesda North Hospital in Cincinnati. Patients were divided into two groups based on the volume of fluid resuscitation in the first 6 hours: restricted (n=604) < 30 mL/kg vs liberal (n=105) ≥30 mL/kg. The primary outcome was in-hospital mortality. Secondary outcomes included initiation of mechanical ventilation within 48 hours and length of stay (LOS) in ICU and hospital. We assessed the data using logistic regression and Wilcoxon rank sum test while adjusting for baseline LVEF, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. AI was used minimally.

Results: Among the restricted vs liberal group, there were no statistically significant differences in sex (288 vs 43, p=0.2) or racial distribution (p=0.9), respectively. Hypertension was higher in the restricted group (52.0% vs. 41.9%, p=0.07), other comorbidities including coronary artery disease (19.4% vs 14.3%, p=0.3), atrial fibrillation (17.4% vs 18.1%, p = 0.10), and COPD (14.9% vs 15.2%, p=1.0) showed no significant differences. Treatment interventions, including fluid administration (p=1) and noninvasive ventilation (p=0.9) did not significantly differ. The median ICU LOS was similar (restricted: 3.00 [IQR: 1.00, 6.00] days; liberal: 3.00 [IQR: 2.00, 8.00] days), but wider distribution was seen in liberal group (p=0.009). Liberal group had higher odds of ICU LOS ≥5 days (OR: 1.7; p = 0.01), ventilation initiation within 48 hours (OR: 2.26; p=0.004), and in-hospital mortality (OR: 1.88; p=0.01). Hospital LOS ≥7 days (p = 0.1) and median total hospital LOS (p = 0.2) did not differ significantly.

Conclusions: Liberal fluid resuscitation in septic shock patients was associated with prolonged ICU LOS, increased need for early ventilation, and higher in-hospital mortality rates. Randomize controlled clinical trials are needed to investigate the impact.