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Randomized Controlled Trial
. 2024 Dec 9;6(12):e1182.
doi: 10.1097/CCE.0000000000001182. eCollection 2024 Dec 1.

Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis-Study of Treatment's Echocardiographic Mechanisms (CLOVERS-STEM)

Michael J Lanspa  1 , Akram Khan  2 , Patrick G Lyons  2 , Michelle N Gong  3 , Ali A Naqvi  3 , Siddharth Dugar  4 , Abhijit Duggal  4 , Nicholas J Johnson  5 , Jacob H Schoeneck  6 , Lane Smith  6 , Somnath Bose  7 , Nathan I Shapiro  7 , Tatyana Shvilkina  7 , Danielle Groat  1 , Jason R Jacobs  1 , Troy D Olsen  1 , Steven Cannavina  1 , Daniel B Knox  1 , Eliotte L Hirshberg  1 , Wesley H Self  8 , Samuel M Brown  1
Affiliations
Randomized Controlled Trial

Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis-Study of Treatment's Echocardiographic Mechanisms (CLOVERS-STEM)

Michael J Lanspa et al. Crit Care Explor. .

Abstract

Importance: Receipt of fluid and vasopressors, common treatments in septic shock, may affect cardiac function.

Objectives: We sought to determine whether a liberal or restrictive fluid resuscitation strategy was associated with changes in cardiac function.

Design: We prospectively studied a subset of patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, performing echocardiography at baseline and at 24 hours after randomization. Among patients who had an echocardiogram performed at 24 hours, we measured left ventricular global longitudinal strain (LV GLS) and right ventricular free-wall longitudinal strain (RVFWLS). We performed linear regressions with dependent variables of LV GLS, change in LV GLS (ΔLV GLS), and RVFWLS using treatment assignment as an independent variable. We adjusted for ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity, mean arterial pressure, and history of congestive heart failure and myocardial infarction.

Setting: Emergency department and ICUs.

Patients: Adults with sepsis enrolled in the CLOVERS trial.

Main outcomes and measures: We enrolled 180 patients. Our analytic cohort comprised 131 patients with an echocardiogram performed at 24 hours. We observed no differences between treatment arms with respect to demographic, clinical, or echocardiographic data at baseline. We observed no association between restrictive fluid assignment and LV GLS (coefficient, 1.22; p = 0.23), ΔLV GLS (-1.97; p = 0.27), or RVFWLS (2.33; p = 0.19).

Conclusions and relevance: In a subset of patients enrolled in CLOVERS, we observed no association between receipt of fluid and vasopressors and short-term changes in cardiac function. Decreased enrollment may limit inferences.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Enrollment of study patients and exclusions leading to final analytic population.
See this image and copyright information in PMC

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References

    1. Angus DC, Linde-Zwirble WT, Lidicker J, et al. : Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303–1310 - PubMed
    1. Zimmerman JE, Kramer AA, Knaus WA: Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 2013; 17:R81. - PMC - PubMed
    1. Shankar-Hari M, Phillips GS, Levy ML, et al. ; Sepsis Definitions Task Force: Developing a new definition and assessing new clinical criteria for septic shock: For the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315:775–787 - PMC - PubMed
    1. Kaukonen KM, Bailey M, Suzuki S, et al. : Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014; 311:1308–1316 - PubMed
    1. Beesley SJ, Weber G, Sarge T, et al. : Septic cardiomyopathy. Crit Care Med 2018; 46:625–634 - PubMed

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