Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis
Abstract Objective In septic patients, multiple retrospective studies show an association between large volumes of fluids administered in the first 24 h and mortality, suggesting a benefit to fluid restrictive strategies. However, these studies do not directly estimate the causal effects of flui...
| Main Authors: | , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | English |
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Springer Science and Business Media LLC
2020
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| Online Access: | https://hdl.handle.net/1721.1/128224 |
| _version_ | 1811094171679719424 |
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| author | Shahn, Zach Shapiro, Nathan I. Tyler, Patrick D. Talmor, Daniel Lehman, Li-Wei |
| author2 | Massachusetts Institute of Technology. Institute for Medical Engineering & Science |
| author_facet | Massachusetts Institute of Technology. Institute for Medical Engineering & Science Shahn, Zach Shapiro, Nathan I. Tyler, Patrick D. Talmor, Daniel Lehman, Li-Wei |
| author_sort | Shahn, Zach |
| collection | MIT |
| description | Abstract
Objective
In septic patients, multiple retrospective studies show an association between large volumes of fluids administered in the first 24 h and mortality, suggesting a benefit to fluid restrictive strategies. However, these studies do not directly estimate the causal effects of fluid-restrictive strategies, nor do their analyses properly adjust for time-varying confounding by indication. In this study, we used causal inference techniques to estimate mortality outcomes that would result from imposing a range of arbitrary limits (“caps”) on fluid volume administration during the first 24 h of intensive care unit (ICU) care.
Design
Retrospective cohort study
Setting
ICUs at the Beth Israel Deaconess Medical Center, 2008–2012
Patients
One thousand six hundred thirty-nine septic patients (defined by Sepsis-3 criteria) 18 years and older, admitted to the ICU from the emergency department (ED), who received less than 4 L fluids administered prior to ICU admission
Measurements and main results
Data were obtained from the Medical Information Mart for Intensive Care III (MIMIC-III). We employed a dynamic Marginal Structural Model fit by inverse probability of treatment weighting to obtain confounding adjusted estimates of mortality rates that would have been observed had fluid resuscitation volume caps between 4 L–12 L been imposed on the population. The 30-day mortality in our cohort was 17%. We estimated that caps between 6 and 10 L on 24 h fluid volume would have reduced 30-day mortality by − 0.6 to − 1.0%, with the greatest reduction at 8 L (− 1.0% mortality, 95% CI [− 1.6%, − 0.3%]).
Conclusions
We found that 30-day mortality would have likely decreased relative to observed mortality under current practice if these patients had been subject to “caps” on the total volume of fluid administered between 6 and 10 L, with the greatest reduction in mortality rate at 8 L. |
| first_indexed | 2024-09-23T15:56:01Z |
| format | Article |
| id | mit-1721.1/128224 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T15:56:01Z |
| publishDate | 2020 |
| publisher | Springer Science and Business Media LLC |
| record_format | dspace |
| spelling | mit-1721.1/1282242022-09-29T17:08:30Z Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis Shahn, Zach Shapiro, Nathan I. Tyler, Patrick D. Talmor, Daniel Lehman, Li-Wei Massachusetts Institute of Technology. Institute for Medical Engineering & Science Abstract Objective In septic patients, multiple retrospective studies show an association between large volumes of fluids administered in the first 24 h and mortality, suggesting a benefit to fluid restrictive strategies. However, these studies do not directly estimate the causal effects of fluid-restrictive strategies, nor do their analyses properly adjust for time-varying confounding by indication. In this study, we used causal inference techniques to estimate mortality outcomes that would result from imposing a range of arbitrary limits (“caps”) on fluid volume administration during the first 24 h of intensive care unit (ICU) care. Design Retrospective cohort study Setting ICUs at the Beth Israel Deaconess Medical Center, 2008–2012 Patients One thousand six hundred thirty-nine septic patients (defined by Sepsis-3 criteria) 18 years and older, admitted to the ICU from the emergency department (ED), who received less than 4 L fluids administered prior to ICU admission Measurements and main results Data were obtained from the Medical Information Mart for Intensive Care III (MIMIC-III). We employed a dynamic Marginal Structural Model fit by inverse probability of treatment weighting to obtain confounding adjusted estimates of mortality rates that would have been observed had fluid resuscitation volume caps between 4 L–12 L been imposed on the population. The 30-day mortality in our cohort was 17%. We estimated that caps between 6 and 10 L on 24 h fluid volume would have reduced 30-day mortality by − 0.6 to − 1.0%, with the greatest reduction at 8 L (− 1.0% mortality, 95% CI [− 1.6%, − 0.3%]). Conclusions We found that 30-day mortality would have likely decreased relative to observed mortality under current practice if these patients had been subject to “caps” on the total volume of fluid administered between 6 and 10 L, with the greatest reduction in mortality rate at 8 L. 2020-10-27T22:30:41Z 2020-10-27T22:30:41Z 2020-02 2019-11 2020-06-26T11:10:17Z Article http://purl.org/eprint/type/JournalArticle 1364-8535 https://hdl.handle.net/1721.1/128224 Shahn, Zach et al. "Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis." Critical Care 24, 1 (February 2020): 62 © 2020 Springer Nature en http://dx.doi.org/10.1186/s13054-020-2767-0 Critical Care Creative Commons Attribution https://creativecommons.org/licenses/by/4.0/ The Author(s). application/pdf Springer Science and Business Media LLC BioMed Central |
| spellingShingle | Shahn, Zach Shapiro, Nathan I. Tyler, Patrick D. Talmor, Daniel Lehman, Li-Wei Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis |
| title | Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis |
| title_full | Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis |
| title_fullStr | Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis |
| title_full_unstemmed | Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis |
| title_short | Fluid-limiting treatment strategies among sepsis patients in the ICU: a retrospective causal analysis |
| title_sort | fluid limiting treatment strategies among sepsis patients in the icu a retrospective causal analysis |
| url | https://hdl.handle.net/1721.1/128224 |
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