الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Approximately 30 million new instances of sepsis are diagnosed annually, and about 6 million individuals worldwide lose their lives to the infection. By adopting a resolution to better study and treat sepsis, the World Health Organization has positioned the issue at the forefront of the conversation over global health policy.
In the middle of 2016, a revised set of sepsis criteria known as Sepsis-3 became available to the public. The term ”sepsis” was often used to refer to the life-threatening malfunctioning of organs caused by an unbalanced response of the host to an infection. It is possible to diagnose organ failure if the patient’s Sequential (sepsis-related) Organ Failure Assessment (SOFA) score increases by 2. The diagnosis of septic shock was made in patients with sepsis who remained hypotensive after receiving sufficient volume resuscitation. Patients with septic shock were given vasopressors to keep their MAP at 65 mmHg, and a lactate level over 2 mmol/l was regarded to be evidence of organ failure and warranted further treatment. The task force is backing a new screening test with a qSOFA ≥ 2, which may help doctors determine whether or not a patient has an infection and whether or not they will need intensive care unit (ICU) admission.
An essential part of resuscitation treatment for cases of circulatory failure is fluid therapy, which is administered to boost the body’s oxygen supply. Hemodynamic resuscitation is a multi-step approach with distinct goals, problems, and consequences at each stage. These stages are called ”resuscitation,” ”optimization,” ”stabilization,” and ”de-escalation,” in that order. Therefore, during the resuscitation phase of septic shock, the current guidelines recommendations of the surviving sepsis campaign support an aggressive fluid resuscitation as long as the patient continues to recover hemodynamically. For the length of the survival of sepsis drive, this remains true. Positive fluid balance due to tissue fluid overflow may be induced by ”liberal” or uncontrolled fluid treatment during the optimization phase. It’s possible that these results will be bad. A recent meta-analysis and systematic review of observational data found that patients with a positive cumulative fluid balance or a fluid overload had an increased risk of death from their condition. Fluids used for maintenance and replenishment, as well as fluids used as a diluent for pharmacological infusions and boluses (a process known as ”fluid creep”), have the potential to produce unintentional salt and chloride loading. More than half of the fluid volume given to patients every day originates from the same sources.
Whether hypotonic or isotonic maintenance solutions should be employed is a matter of heated controversy. Research suggests that hypotonic solutions may cause hyponatremia and neurological problems in infants and toddlers. Using 5% dextrose as the regular maintenance fluid and as the vehicle of drug infusion and boluses has been linked to a reduction in the quantity of administered salt in critically sick patients, as shown by the results of a before-and-after prospective investigation. The person began urinating more often and lost some of their previously gained fluid volume after this modification took place. Another research discovered that patients with fluid overload had more severe multi-organ failure from the resuscitation phase through day 5 of septic shock; however, differences in Delta SOFA scores did not become evident until day 3.
The SOFA score is one of the best validated disease-oriented end points available for critically ill patients and is correlated with mortality risk Serial SOFA score measurement is clinically meaningful and reflects global patient’s deterioration or improvement during the course of sepsis.
We hypothesise that the administration of 5% Dextrose for fluid maintenance and drug infusion in critically ill septic shock patients will lead to a decrease in SOFA score when compared to administration of 0.9% NaCl.
This study aimed to compare the efficacy of maintenance fluid therapy by 5% dextrose compared to 0.9% NaCl in reducing organ dysfunction in critically ill sepsis patients.
This prospective interventional randomized controlled clinical trial was conducted on 60 adults with septic shock (age > 18 years old) and needed for maintenance fluid as determined by the treating clinician.
Patients were equally classified into:
A. The Dextrose arm:
1. 50% of fluids given in the ICU in the form of fluid boluses or infusions was given in the form of water; D5%.
2. The other 50% was given in the form of NS. Once resuscitation targeted parameter was achieved (MAP>70 mmHg for at least three hours & lactate clearance), all fluids given e.g., vehicle of drug infusion, maintenance or even boluses were given in the form of water; D5% for first 72 hours in the ICU.
3. The treating clinicians determine the volume and infusion rate of each individual patient.