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Background:
We are all familiar with the Surviving Sepsis Campaign recommendation (& CMS core measure) for an initial 30ml/kg bolus of IV crystalloid within the first 3 hours for our patients with septic shock. There is minimal data, however, on how much IVF we should be giving our patients with BMIs ≥30.
A recent study in obese patients with septic shock retrospectively stratified the total fluids administered at 3 hours into 3 different weight categories, to categorize patients as having received 30mL per kg of ___ body weight, whether actual (ABW), adjusted (AjdBW), or ideal (IBW**).
AdjBW = (ABW – IBW) *40% + IBW
They found:
- Most patients received fluids based on actual body weight, BUT
- Patients at highest BMIs received ABW fluids less often
- 30ml/kg dosing according to adjusted body weight was associated with improved mortality compared to IVF per actual or ideal body weight.
Bottom Line:
- If the 30ml/kg IVF bolus seems clinically appropriate for your obese patient, consider administering according to Adjusted Body Weight first.
- As always, reevaluate your septic shock patients frequently to determine if additional fluids are necessary, and go to vasopressors early if they are not fluid responsive.
**IBW calculated using Devine’s formula for men and women:
- Males: IBW = 50 + 2.3*(# inches over 5 feet)
- Females: IBW = 45.5 + 2.3*(# inches over 5 feet)
References
- Taylor SP, Karvetski CH, Templin MA, et al. Initial fluid resuscitation following adjusted body weight dosing is associated with improved mortality in obese patients with suspected septic shock. J Crit Care. 2017;43: 7-12.
- Rhodes A, Evans LE, Alhazzani, et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and shock: 2016. Crit Care Med. 2017;45(3): 486-552.