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

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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.
OriginalsprogEngelsk
TidsskriftIntensive Care Medicine
Vol/bind50
Udgave nummer5
Sider (fra-til)678-686
Antal sider9
ISSN0342-4642
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
Open access funding provided by Karolinska Institute. The original CLASSIC study was supported by a grant from the Novo Nordisk Foundation and by the Sofus Friis\u2019 Foundation, the Rigshospitalets Research Council and the Danish Society of Anesthesiology and Intensive Care Medicine. This study was supported by grants from Scandinavian Society of Anesthesia and Intensive Care Medicine (SSAI), Stockholm County Council and the Olof Norlander memorial fund.

Publisher Copyright:
© The Author(s) 2024.

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