Association Between Mortality and Vasoactive Agent Initiation Time During Fluid Resuscitation in Septic Shock

The mortality remains high in septic shock patients treated by early goal-directed therapy (EGDT) protocol compared with conventional therapy. The Surviving Sepsis Campaign recommends the treatments for septic shock patients are early fluid resuscitation, antimicrobial and vasoactive agents administration. This study aimed to determine the initiation time of vasoactive agents during fluid resuscitation process in an Intensive Care Unit (ICU) could influence septic shock intra-hospital mortality. This study was a retrospective cohort study involving 781 septic shock patient medical records in Cipto Mangunkusumo Hospital ICU from 2013–2016. The subjects were divided into two groups; septic shock patients that received vasoactive therapy within 6 hours and after 6 hours during fluid resuscitation process. This study found 188 septic shock patients documented were suitable for analysis. There is a significant difference in cumulative fluid balance between 2 groups (959.9±1231.5 ml vs. 646.0±707.7 ml, p < 0.05), but the association between mortality and vasoactive administration time was not statistically significant by Chi-square test (p = 0.282) with RR 1.060 (95% CI 0.974–1.153). There is no association between septic shock in-hospital mortality and the initiation time of vasoactive therapy administration during resuscitation process.