dc.contributor.author | Macdonald, Stephen PJ | |
dc.contributor.author | Keijzers, Gerben | |
dc.contributor.author | Taylor, David McD | |
dc.contributor.author | Kinnear, Frances | |
dc.contributor.author | Arendts, Glenn | |
dc.contributor.author | Fatovich, Daniel M | |
dc.contributor.author | Bellomo, Rinaldo | |
dc.contributor.author | McCutcheon, David | |
dc.contributor.author | Fraser, John F | |
dc.contributor.author | Ascencio-Lane, Juan-Carlos | |
dc.contributor.author | Burrows, Sally | |
dc.contributor.author | Litton, Edward | |
dc.contributor.author | Harley, Amanda | |
dc.contributor.author | Anstey, Matthew | |
dc.contributor.author | Mukherjee, Ashes | |
dc.date.accessioned | 2019-06-26T06:01:13Z | |
dc.date.available | 2019-06-26T06:01:13Z | |
dc.date.issued | 2018 | |
dc.identifier.issn | 0342-4642 | |
dc.identifier.doi | 10.1007/s00134-018-5433-0 | |
dc.identifier.uri | http://hdl.handle.net/10072/382819 | |
dc.description.abstract | Purpose:
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.peerreviewed | Yes | |
dc.language | English | |
dc.language.iso | eng | |
dc.publisher | SPRINGER | |
dc.relation.ispartofpagefrom | 2070 | |
dc.relation.ispartofpageto | 2078 | |
dc.relation.ispartofissue | 12 | |
dc.relation.ispartofjournal | INTENSIVE CARE MEDICINE | |
dc.relation.ispartofvolume | 44 | |
dc.subject.fieldofresearch | Clinical sciences | |
dc.subject.fieldofresearch | Health services and systems | |
dc.subject.fieldofresearch | Public health | |
dc.subject.fieldofresearchcode | 3202 | |
dc.subject.fieldofresearchcode | 4203 | |
dc.subject.fieldofresearchcode | 4206 | |
dc.title | Restricted fluid resuscitation in suspected sepsis associated hypotension (REFRESH): a pilot randomised controlled trial | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dc.type.code | C - Journal Articles | |
gro.hasfulltext | No Full Text | |
gro.griffith.author | Keijzers, Gerben | |
gro.griffith.author | Fraser, John F. | |