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dc.contributor.authorMacdonald, Stephen PJ
dc.contributor.authorKeijzers, Gerben
dc.contributor.authorTaylor, David McD
dc.contributor.authorKinnear, Frances
dc.contributor.authorArendts, Glenn
dc.contributor.authorFatovich, Daniel M
dc.contributor.authorBellomo, Rinaldo
dc.contributor.authorMcCutcheon, David
dc.contributor.authorFraser, John F
dc.contributor.authorAscencio-Lane, Juan-Carlos
dc.contributor.authorBurrows, Sally
dc.contributor.authorLitton, Edward
dc.contributor.authorHarley, Amanda
dc.contributor.authorAnstey, Matthew
dc.contributor.authorMukherjee, Ashes
dc.description.abstractPurpose: To determine if a regimen of restricted fluids and early vasopressor compared to usual care is feasible for initial resuscitation of hypotension due to suspected sepsis. Methods: A prospective, randomised, open-label, clinical trial of a restricted fluid resuscitation regimen in the first 6 h among patients in the emergency department (ED) with suspected sepsis and a systolic blood pressure under 100 mmHg, after minimum 1000 ml of IV fluid. Primary outcome was total fluid administered within 6 h post randomisation. Results There were 99 participants (50 restricted volume and 49 usual care) in the intention-to-treat analysis. Median volume from presentation to 6 h in the restricted volume group was 2387 ml [first to third quartile (Q1–Q3) 1750–2750 ml]; 30 ml/kg (Q1–Q3 32–39 ml/kg) vs. 3000 ml (Q1–Q3 2250–3900 ml); 43 ml/kg (Q1–Q3 35–50 ml/kg) in the usual care group (p < 0.001). Median duration of vasopressor support was 21 h (Q1–Q3 9–42 h) vs. 33 h (Q1–Q3 15–50 h), (p = 0.13) in the restricted volume and usual care groups, respectively. At 90-days, 4 of 48 (8%) in the restricted volume group and 3 of 47 (6%) in the usual care group had died. Protocol deviations occurred in 6/50 (12%) in restricted group and 11/49 (22%) in the usual care group, and serious adverse events in four cases (8%) in each group. Conclusions: A regimen of restricted fluids and early vasopressor in ED patients with suspected sepsis and hypotension appears feasible. Illness severity was moderate and mortality rates low. A future trial is necessary with recruitment of high-risk patients to determine effects on clinical outcomes in this setting.
dc.relation.ispartofjournalINTENSIVE CARE MEDICINE
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchPublic Health and Health Services
dc.titleRestricted fluid resuscitation in suspected sepsis associated hypotension (REFRESH): a pilot randomised controlled trial
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.hasfulltextNo Full Text
gro.griffith.authorKeijzers, Gerben
gro.griffith.authorFraser, John F.

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