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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.date.accessioned2019-06-26T06:01:13Z
dc.date.available2019-06-26T06:01:13Z
dc.date.issued2018
dc.identifier.issn0342-4642
dc.identifier.doi10.1007/s00134-018-5433-0
dc.identifier.urihttp://hdl.handle.net/10072/382819
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.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofpagefrom2070
dc.relation.ispartofpageto2078
dc.relation.ispartofissue12
dc.relation.ispartofjournalINTENSIVE CARE MEDICINE
dc.relation.ispartofvolume44
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchPublic Health and Health Services
dc.subject.fieldofresearchcode1103
dc.subject.fieldofresearchcode1117
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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