{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T17:02:35Z","timestamp":1794070955730,"version":"4.8.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2015,12,1]],"date-time":"2015-12-01T00:00:00Z","timestamp":1448928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Survivors of septic shock have impaired functional status. Volume overload is associated with poor outcomes in patients with septic shock, but the impact of volume overload on functional outcome and discharge destination of survivors is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study describes patterns of fluid management both during and after septic shock. We examined factors associated with volume overload upon intensive care unit (ICU) discharge. We then examined associations between volume overload upon ICU discharge, mobility limitation, and discharge to a healthcare facility in septic shock survivors, with the hypothesis that volume overload is associated with increased odds of these outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the medical records of 247 patients admitted with septic shock to an academic county hospital between June 2009 and April 2012 who survived to ICU discharge. We defined volume overload as a fluid balance expected to increase the subject\u2019s admission weight by 10%. Statistical methods included unadjusted analyses and multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Eighty-six percent of patients had a positive fluid balance, and 35% had volume overload upon ICU discharge. Factors associated with volume overload in unadjusted analyses included more severe illness, cirrhosis, blood transfusion during shock, and higher volumes of fluid administration both during and after shock. Blood transfusion during shock was independently associated with increased odds of volume overload (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.33\u20135.27; P\u2009=\u20090.01) after adjusting for preexisting conditions and severity of illness. Only 42% of patients received at least one dose of a diuretic during their hospitalization. Volume overload upon ICU discharge was independently associated with inability to ambulate upon hospital discharge (OR, 2.29; 95% CI, 1.24\u20134.25; P\u2009=\u20090.01) and, in patients admitted from home, upon discharge to a healthcare facility (OR, 2.34; 95% CI, 1.1\u20134.98; P\u2009=\u20090.03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Volume overload is independently associated with impaired mobility and discharge to a healthcare facility in survivors of septic shock. Prevention and treatment of volume overload in patients with septic shock warrants further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201504-187oc","type":"journal-article","created":{"date-parts":[[2015,9,22]],"date-time":"2015-09-22T11:49:44Z","timestamp":1442922584000},"page":"1837-1844","source":"Crossref","is-referenced-by-count":112,"title":["Volume Overload: Prevalence, Risk Factors, and Functional Outcome in Survivors of Septic Shock"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1743-7976","authenticated-orcid":false,"given":"Kristina H.","family":"Mitchell","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Carlbom","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5716-248X","authenticated-orcid":false,"given":"Peter J.","family":"Leary","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Himmelfarb","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Kidney Research Institute, University of Washington School of Medicine, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine L.","family":"Hough","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,12,1]]},"reference":[{"key":"2026012303361117000_bib1","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1097\/00003246-200107000-00002","article-title":"Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care","volume":"29","author":"Angus","year":"2001","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib2","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1056\/NEJMoa022139","article-title":"The epidemiology of sepsis in the United States from 1979 through 2000","volume":"348","author":"Martin","year":"2003","journal-title":"N Engl J Med"},{"key":"2026012303361117000_bib3","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1378\/chest.11-0352","article-title":"Nationwide trends of severe sepsis in the 21st century (2000-2007)","volume":"140","author":"Kumar","year":"2011","journal-title":"Chest"},{"key":"2026012303361117000_bib4","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1001\/jama.2010.1553","article-title":"Long-term cognitive impairment and functional disability among survivors of severe sepsis","volume":"304","author":"Iwashyna","year":"2010","journal-title":"JAMA"},{"key":"2026012303361117000_bib5","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1111\/j.1532-5415.2012.03989.x","article-title":"Population burden of long-term survivorship after severe sepsis in older Americans","volume":"60","author":"Iwashyna","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"2026012303361117000_bib6","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1097\/CCM.0b013e31827e83af","article-title":"Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012","volume":"41","author":"Dellinger","year":"2013","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib7","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1056\/NEJMoa010307","article-title":"Early goal-directed therapy in the treatment of severe sepsis and septic shock","volume":"345","author":"Rivers","year":"2001","journal-title":"N Engl J Med"},{"key":"2026012303361117000_bib8","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1056\/NEJMoa1401602","article-title":"A randomized trial of protocol-based care for early septic shock","volume":"370","author":"Yealy","year":"2014","journal-title":"N Engl J Med"},{"key":"2026012303361117000_bib9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/SHK.0000000000000268","article-title":"Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death","volume":"43","author":"Kelm","year":"2015","journal-title":"Shock"},{"key":"2026012303361117000_bib10","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/01.CCM.0000194725.48928.3A","article-title":"Sepsis in European intensive care units: results of the SOAP study","volume":"34","author":"Vincent","year":"2006","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib11","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jcrc.2014.09.002","article-title":"Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock","volume":"30","author":"de Oliveira","year":"2015","journal-title":"J Crit Care"},{"key":"2026012303361117000_bib12","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/CCM.0b013e3181feeb15","article-title":"Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality","volume":"39","author":"Boyd","year":"2011","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib13","doi-asserted-by":"crossref","first-page":"R246","DOI":"10.1186\/cc13072","article-title":"Fluid balance and cardiac function in septic shock as predictors of hospital mortality","volume":"17","author":"Micek","year":"2013","journal-title":"Crit Care"},{"key":"2026012303361117000_bib14","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1378\/chest.117.6.1749","article-title":"Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study","volume":"117","author":"Alsous","year":"2000","journal-title":"Chest"},{"key":"2026012303361117000_bib15","doi-asserted-by":"crossref","first-page":"2564","DOI":"10.1056\/NEJMoa062200","article-title":"Comparison of two fluid-management strategies in acute lung injury","volume":"354","author":"National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network","year":"2006","journal-title":"N Engl J Med"},{"key":"2026012303361117000_bib16","first-page":"A3951","article-title":"Fluid management of sepsis after shock resolution: an analysis of intensive care unit volume status in relation to mobility on hospital discharge [abstract]","volume":"187","author":"Mitchell","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012303361117000_bib17","first-page":"A1124","article-title":"Fluid management of sepsis after shock resolution: an analysis of practice variation and risk factors [abstract]","volume":"185","author":"Mitchell","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012303361117000_bib18","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1097\/01.CCM.0000050454.01978.3B","article-title":"2001 SCCM\/ESICM\/ACCP\/ATS\/SIS International Sepsis Definitions Conference","volume":"31","author":"Levy","year":"2003","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib19","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1007\/s00467-004-1655-1","article-title":"Effect of fluid overload and dose of replacement fluid on survival in hemofiltration","volume":"19","author":"Gillespie","year":"2004","journal-title":"Pediatr Nephrol"},{"key":"2026012303361117000_bib20","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1038\/ki.2009.159","article-title":"Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury","volume":"76","author":"Bouchard","year":"2009","journal-title":"Kidney Int"},{"key":"2026012303361117000_bib21","first-page":"67","article-title":"Washington state hospital data dictionary, version CVW4","author":"Washington State Department of Health","year":"2011"},{"key":"2026012303361117000_bib22","article-title":"Functional assessment in rehabilitation medicine","author":"Granger","year":"1984"},{"key":"2026012303361117000_bib23","article-title":"The FIM Instrument: its background, structure, and usefulness","author":"Uniform Data System for Medical Rehabilitation (UDSMR)","year":"2012"},{"key":"2026012303361117000_bib24","doi-asserted-by":"crossref","first-page":"R31","DOI":"10.1186\/cc5713","article-title":"Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury","volume":"11","author":"Mehta","year":"2007","journal-title":"Crit Care"},{"key":"2026012303361117000_bib25","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1056\/NEJMoa1500896","article-title":"Trial of early, goal-directed resuscitation for septic shock","volume":"372","author":"Mouncey","year":"2015","journal-title":"N Engl J Med"},{"key":"2026012303361117000_bib26","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1056\/NEJMoa1404380","article-title":"Goal-directed resuscitation for patients with early septic shock","volume":"371","author":"Peake","year":"2014","journal-title":"N Engl J Med"},{"key":"2026012303361117000_bib27","doi-asserted-by":"crossref","first-page":"966","DOI":"10.2215\/CJN.08781010","article-title":"Fluid balance, diuretic use, and mortality in acute kidney injury","volume":"6","author":"Grams","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026012303361117000_bib28","doi-asserted-by":"crossref","first-page":"R74","DOI":"10.1186\/cc6916","article-title":"A positive fluid balance is associated with a worse outcome in patients with acute renal failure","volume":"12","author":"Payen","year":"2008","journal-title":"Crit Care"},{"key":"2026012303361117000_bib29","doi-asserted-by":"crossref","first-page":"R14","DOI":"10.1186\/cc12484","article-title":"Fluid balance and urine volume are independent predictors of mortality in acute kidney injury","volume":"17","author":"Teixeira","year":"2013","journal-title":"Crit Care"},{"key":"2026012303361117000_bib30","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1164\/rccm.201111-2025OC","article-title":"The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury","volume":"185","author":"Mikkelsen","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012303361117000_bib31","doi-asserted-by":"crossref","first-page":"R186","DOI":"10.1186\/cc8179","article-title":"Effect of fluid resuscitation on mortality and organ function in experimental sepsis models","volume":"13","author":"Brandt","year":"2009","journal-title":"Crit Care"},{"key":"2026012303361117000_bib32","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/0885066607305247","article-title":"Abdominal compartment syndrome is common in medical intensive care unit patients receiving large-volume resuscitation","volume":"22","author":"Daugherty","year":"2007","journal-title":"J Intensive Care Med"},{"key":"2026012303361117000_bib33","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1097\/00003246-199107000-00022","article-title":"Lung fluid dynamics and supply dependency of oxygen uptake during experimental endotoxic shock and volume resuscitation","volume":"19","author":"D\u2019Orio","year":"1991","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib34","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jacc.2008.05.068","article-title":"Importance of venous congestion for worsening of renal function in advanced decompensated heart failure","volume":"53","author":"Mullens","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2026012303361117000_bib35","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1471-2253-13-17","article-title":"Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: a hypothesis generating post hoc analysis","volume":"13","author":"Vellinga","year":"2013","journal-title":"BMC Anesthesiol"},{"key":"2026012303361117000_bib36","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1113\/jphysiol.1931.sp002761","article-title":"The influence of venous pressure on the isolated mammalian kidney","volume":"72","author":"Winton","year":"1931","journal-title":"J Physiol"},{"key":"2026012303361117000_bib37","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13613-014-0021-0","article-title":"Iatrogenic salt water drowning and the hazards of a high central venous pressure","volume":"4","author":"Marik","year":"2014","journal-title":"Ann Intensive Care"},{"key":"2026012303361117000_bib38","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1007\/BF00195781","article-title":"Skeletal muscle oedema and muscle fibre necrosis during septic shock: observations with a porcine septic shock model","volume":"424","author":"Hauptmann","year":"1994","journal-title":"Virchows Arch"},{"key":"2026012303361117000_bib39","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1172\/JCI110820","article-title":"Regulation of renal blood flow by plasma chloride","volume":"71","author":"Wilcox","year":"1983","journal-title":"J Clin Invest"},{"key":"2026012303361117000_bib40","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/SLA.0b013e318256be72","article-title":"A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and Plasma-Lyte 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers","volume":"256","author":"Chowdhury","year":"2012","journal-title":"Ann Surg"},{"key":"2026012303361117000_bib41","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1097\/CCM.0000000000000305","article-title":"Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis","volume":"42","author":"Raghunathan","year":"2014","journal-title":"Crit Care Med"},{"key":"2026012303361117000_bib42","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1042\/cs1040017","article-title":"(Ab)normal saline and physiological Hartmann\u2019s solution: a randomized double-blind crossover study","volume":"104","author":"Reid","year":"2003","journal-title":"Clin Sci (Lond)"},{"key":"2026012303361117000_bib43","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1001\/jama.2012.13356","article-title":"Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults","volume":"308","author":"Yunos","year":"2012","journal-title":"JAMA"},{"key":"2026012303361117000_bib44","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1097\/CCM.0000000000001161","article-title":"Association of hyperchloremia with hospital mortality in critically ill septic patients","volume":"43","author":"Neyra","year":"2015","journal-title":"Crit Care Med"}],"container-title":["Annals of the American Thoracic Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/12\/12\/1837\/66552901\/annalsats_12_12_1837.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/12\/12\/1837\/66552901\/annalsats_12_12_1837.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:36:25Z","timestamp":1769157385000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annalsats\/article\/12\/12\/1837\/8429063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,1]]},"references-count":44,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2015,12,1]]},"published-print":{"date-parts":[[2015,12,1]]}},"URL":"https:\/\/doi.org\/10.1513\/annalsats.201504-187oc","relation":{},"ISSN":["2329-6933","2325-6621"],"issn-type":[{"value":"2329-6933","type":"print"},{"value":"2325-6621","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2015,12]]},"published":{"date-parts":[[2015,12,1]]}}}