Effect of deresuscitation management vs. usual care on ventilator-free days in patients with abdominal septic shock

BACKGROUND: The effect of deresuscitation management on weaning from invasive mechanical ventilation (IMV) in abdominal septic shock after initial fluid resuscitation remains unknown. This study aimed to determine if deresuscitation management of abdominal septic shock patients is superior to one that uses usual care protocol.METHODS: Abdominal septic shock patients receiving IMV and admitted to the intensive care unit (ICU) following initial fluid resuscitation were randomly assigned to deresuscitation guided by dynamic evaluation fluid responsiveness or usual care. The number of ventilator-free days (VFDs) and success rate of weaning from ventilator were compared between groups. Daily and cumulative fluid accumulation, length of stay (LOS), and ICU mortality were recorded.RESULTS: Ninety patients were enrolled, 45 assigned to deresuscitation and 45 to usual care. The number of VFDs was 19.2±9.5 vs. 13.3±11.1 (P=0.008) in the deresuscitation and usual care groups, respectively. The success rate of weaning from the ventilator as early as day 3 was significantly higher in the deresuscitation group than in the usual care group (44.4% vs. 17.8%, P=0.006). In deresuscitation group patients, cumulative fluid accumulation was less at the end of day 3 (-1007.3±2939.0 vs. 3037.9±2996.5 mL, P<0.05). ICU LOS was lower in the deresuscitation group than in the usual care group (12.4±9.5 vs. 18.0±15.3 days, P=0.04). There was no significant difference in ICU mortality between groups (15.6% vs. 28.9%, P=0.128).CONCLUSIONS: Deresuscitation management of abdominal septic shock patients increases the number of VFDs, facilitates early weaning from the ventilator, and significantly reduces the volume of fluid accumulation compared to usual care.