1705. Timeliness of Fluid Resuscitation in HIV Positive Patients who have Septic Shock is Associated with Survival
Session: Poster Abstract Session: HIV: HIV and ICU Outcomes
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Slide1.png (164.0 kB)
  • Background: Fluid resuscitation is a vital part of initial resuscitation in severe sepsis and septic shock.  However, excess fluid and fluid given beyond the initial 6 hours may lead to worsened outcomes.  This may be more critical in HIV positive patients who may suffer from different pathogens, concurrently have other HIV associated illnesses and may be severely malnourished.  Therefore we hypothesize that an increased volume of fluid infused after the first 6 hours of resuscitation in septic shock is associated with lower ICU and 90-day survival in patients who are also HIV positive. 

    Methods: Retrospective, multicenter, cohort study of 255 patients with septic shock who were also HIV positive admitted to the intensive care units of 28 academic and community hospitals in three countries between 1996 and 2007. We used logistic regression to investigate the association between volume of fluid infused during the first 24 hours and ICU and 90-day survival, after adjustment for severity of illness (APACHE II score) and body weight (BMI).

    Results:  Total volume of fluid infused during the first 24 hours was not associated with ICU or 90-day survival (p=0.7 and p=0.9).  However, volume of fluid infused before 6 hours was associated with increased ICU (OR=1.8, 95%Cl 3.3-0.97, p=0.06) and 90-day (OR=1.9, 95%CI 3.4-1.0, p=0.03) survival whereas volume of fluid infused between 6 and 24 hours was associated with decreased ICU (OR=0.60, 95%CI 0.39-0.99, p=0.05) and 90-day (OR=0.62, 95%CI 0.37-0.97, p=0.04) survival. Increased BMI was also associated with decreased ICU (OR=0.83, 95% CI0.69-0.99, p=0.04] and 90-day (OR=0.81, 95% CI 0.67-0.97, p=0.02) survival.

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    Conclusion: Amongst HIV positive patients admitted to the ICU for severe sepsis and septic shock quantity as well as timing are important determinants of survival.

    James J Douglas, MD1, Christopher D. Fjell, PhD1, Keith R Walley, MD1, Peter M Dodek, MD2 and Anand Kumar, MD3, (1)Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada, (2)Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada, (3)Section of Critical Care Medicine, Health Sciences Centre/St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada

    Disclosures:

    J. J. Douglas, None

    C. D. Fjell, None

    K. R. Walley, None

    P. M. Dodek, None

    A. Kumar, None

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