The Association Between Time to Completion of at Least 30 mL/kg and Hospital Outcomes Among Patients With Septic Shock.

Importance: Sepsis is the leading cause of inpatient mortality in the United States. The optimal timing and volume of fluid resuscitation for septic shock remain a topic of debate.

Objectives: This study evaluated the effect of time to completion of at least 30 mL/kg of fluid and the impact of smaller fluid volumes on hospital outcomes among patients with septic shock.

Design, setting, and participants: Retrospective cohort study in a large community healthcare system (310,000 annual emergency visits) of all adults (age ≥ 18 yr) admitted from January 2017 to December 2022 with an International Classification of Diseases, 10th Revision diagnosis of sepsis and an initial emergency department (ED) systolic blood pressure (SBP) less than 90 mm Hg, mean arterial blood pressure less than 65 mm Hg, and/or lactate greater than or equal to 4 mmol/L.

Main outcomes and measures: The main outcomes include hospital mortality, ICU admission, mechanical ventilation, and vasopressor use. The relationship between time to completion of 30 mL/kg and the main outcomes was assessed using generalized linear models.

Results: Among the 1602 patients who met inclusion criteria, 1190 (74.3%) received at least 30 mL/kg of fluid after ED arrival. The overall mortality rate was 24.2%, with 28.7% requiring mechanical ventilation and 64.3% requiring vasopressors. Receipt of at least 30 mL/kg between 2 and 3 hours from the time of initial ED SBP (time zero) was associated with lower odds of mortality (odds ratio [OR], 0.61; 95% CI, 0.39-0.97; p = 0.04) and mechanical ventilation use (OR, 0.43; 95% CI, 0.29-0.65; p < 0.01) compared with other intervals. Compared with receiving 30 mL/kg or greater, receiving at least 20 but less than 30 mL/kg within the first hour was associated with the lowest odds of mortality (OR, 0.33; 95% CI, 0.11-0.97; p = 0.04).

Conclusions and relevance: Our findings show that receipt of 30 mL/kg of fluid within 3 hours is associated with reduced mortality and the need for mechanical ventilation among patients with septic shock. These results support the current Surviving Sepsis Campaign fluid recommendations.