Prolonged Overexpansion of Extracellular Water in Elderly Patients With Sepsis

Abstract

ONE OF the hallmarks of aging is a decreased ability to respond adaptively to environmental challenges.¹ This loss of physiological and metabolic reserve results in a diminished capacity to maintain homeostasis, and there is evidence to suggest that the mechanisms responsible for restoring body fluid composition to normal after injury or during critical illness may not function as effectively in the elderly as in younger patients.^2,3 After resuscitation of the patient with sepsis, a period of obligatory extravascular sequestration of fluid occurs and results in overexpansion of the extracellular fluid volume.^4,5 Current evidence suggests that elderly patients may respond less favorably to this large fluid load than younger patients, and we wondered if excessive or prolonged extracellular fluid expansion occurred and whether this contributed to a poorer outcome from critical illness. For this reason, we made sequential measurements of extracellular water (ECW) in a group of elderly patients with severe sepsis and compared the results with those obtained from a similar group of younger patients.