Date of Award

8-15-2020

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Meredith Wold, PA-C

Abstract

Sepsis and septic shock continue to be major causes of in-hospital mortality. The World Health Organization (WHO) declared sepsis as a global health top priority as of 2017. To combat sepsis mortality, the Surviving Sepsis Campaign (SSC) released the first set of guidelines in 2004 and continues to publish treatment guidelines, updating the guidelines every four years based on emerging evidence. The 2018 update to the 2016 guidelines contains an Hour-1 Bundle released by the SSC, which includes a rapid infusion of a 30 ml/kg fluid bolus as a strong recommendation with low quality evidence. Recently, studies have challenged this recommendation, demonstrating complications due to fluid overload when following the guideline. This continues to be a source of controversy, as the fluid bolus is included in the Centers for Medicare and Medicaid Services SEP-1 performance measure, requiring healthcare practitioners to administer the bolus despite the risks of harm. A literature review was conducted utilizing PubMed to explore the following question: in adult patients with sepsis or septic shock, does initially administering at least 30 ml/kg of fluid improve morbidity and mortality compared to other treatment modalities, such as a fluid restrictive approach or early introduction of vasopressors? The null hypothesis was that there would be no difference amongst treatment modalities. This review revealed that giving a standard 30 ml/kg fluid bolus may be harmful, potentially leading to poorer outcomes. Alternative fluid administration approaches are discussed.

Identifier

SC 11.PAS.2020.Olsson.A

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