EUH Dressler Conference: What is the most appropriate timeframe for administering IV fluids to patients with sepsis or septic shock?

The Bottom Line: The Surviving Sepsis Guideline states 30cc/kg within first 3 hours for sepsis or shock, as defined by new Sepsis definitions (Singer et al, 2016).

References: Leisman D, Wie B, Doerfler M, Bianculli A, et al. Association of fluid resuscitation initiation within 30 minutes of severe sepsis and septic shock recognition with reduced mortality and length of stay. Annals of Emergency Medicine. 2016 Sep;68(3):298-311. doi:10.1016./j.annemergmed.2016.02.044.

Seymour CW, Gesten F, Prescott HC, Friedrich ME, et al. Time to treatment and mortality during mandated emergency care for sepsis. NEJM. 2017 Jun 8;376(23):2235-2244. doi:10.1056/NEJMoa1703058.

Singer, M, Deutschman CS, Seymour CW. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287.

Summary: While some of the recent data on timing of IVFs (Seymour et al, 2017) suggest that completion of the initial IVF bolus within the first 3 hours is not associated with mortality improvement compared to completion of the initial IVF bolus beyond 3 hours, other data (Leisman et al, 2016) suggest that the earlier initiation of IVFs (within the first 30 minutes) is associated with improved mortality and reduced hospital length of stay.

The current guidelines, as listed in DynaMed Plus, call for fluids within 3 hours.

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