Effects of the First 72 Hours of Positive Fluid Balance on the Development of Acute Kidney Injury and Mortality in Patients With Septic Shock. (a Retrospective Cohort Study)

Abstract

Background: Septic shock is defined as severe sepsis with evidence of cardiovascular system dysfunction. A state of shock causes inadequate tissue perfusion that leads into inadequate oxygen delivery to meet cellular metabolic needs. Appropriate fluid management is compulsory for the restoration of adequate cardiac output, tissue perfusion and restoration of organs function. However, excess fluid can be fatal and has been linked to multiple organ dysfunction, increased length of hospital stay, ventilator dependence as well as increased mortality. KNH PICU has a high mortality rate of septic shock in the first 72 hours of admission. We intend to determine whether the excessive fluid administration contributes to this mortality. Objective: To determine the effects of fluid balance in the first 72 hours of septic shock in children admitted to the KNH PICU. Justification and Utility: The results from this study will help assess how fluid management in critically ill PICU patients with septic shock may affect early mortality and organ dysfunction. This study will provide data to aid in developing an ideal fluid management strategy that may help reduce organ dysfunction and mortality in pediatric patients presenting with septic shock. Given the high numbers of patients with septic shock and their high rate of mortality in the KNH PICU, future PICU patients will benefit from the results of this study. Methodology: ix Study design: Retrospective study. Study site/ setting: Kenyatta National Hospital Paediatric Intensive Care Unit. Study population: Paediatric patients (1-12 years) admitted with septic shock. Study procedure: Patients admitted with septic shock will be retrospectively identified over the past 2 years (from January 2019 to December 2020) and recorded and from them 162 patients’ numbers will be randomly selected. Using the selected numbers, the files will be selected from the medical records department and data collected and documented on an excel spreadsheet for data analysis. Data analysis and management: Data management will be done in Microsoft Excel 2016 data entry sheet. The data will be exported into IBM SPSS version 23 for statistical analysis. The demographic data will be put into percentages and continuous variables into means or medians. The relationship between fluid overload and outcome variables will be examined using bivariate and multivariate analyses. The significance of association and strength of the relationship between variables will be explained using p-values, odds ratios and confidence intervals. The study findings will be presented using tables and graphs