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Title: | The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand. | Authors: | Tan E.;Burcham J.;Coggins A.R.;Delaney A.;Fatovich D.M.;Fraser J.F.;Harley A.;Jones P.;Kinnear F.B.;May K.;Peake S.;Williams P.;Nguyen K.;Foong L.H.;Hullick C.;McNulty R.;Na A.;Trethewy C.;Lutze L.;Zhang M.;Cowan T.;Middleton P.;Avis S.;Vidler S.;Salter M.;Janes S.;Harwood T.;Oliver M.;Jazayeri F.;Jones S.;Davoren M.;Coggins A.;Pradhananga B.;Newby L.;Beck S.;Sandleback B.;Rabas S.;Harger S.;Song R.;Gutenstein M.;Munro A.;Connely M.;Goodson J.;Mclean A.;Brabyn C.;Mukerji S.;Simmonds H.;Young P.;Sugeng Y.;Bird C.;McConnell A.;Henderson P.;Johnson D.;Perez S.;Mahani A.;Orda U.;Thom O.;Roberts K.;Kinnear F.;Hazelwood S.;Pham H.;Eley R.;Livesay G.;Devlin M.;Murdoch I.;Wood E.;Williams J.;Brown N.;King A.;Sadewasser J.;Jones L.;Gangathimmaiah V.;Manudhane A.;Haustead D.;Ascencio-Lane J.-C.;Taylor D.M.;Buntine P.;Walker K. ;Pouryahya P. ;Crompton D.;Sultana R.;Campbell T.;Dwyer R.;Blecher G. ;Knott J.;Mitra B.;Luckhoff C.;Young R.;Rudling N.;Mukherjee A.;Dyke K.-L.;Parker C.;Cooper A.;Nagree Y.;Koay K.;Kruger C.;Ghedina N.;Smedley B.;Macdonald S.;Hamersley H.;Keijzers G.;Macdonald S.P.J.;Udy A.A.;Arendts G.;Bailey M.;Bellomo R.;Blecher G.E. | Monash Health Department(s): | Emergency Medicine | Institution: | (Keijzers, Harley, May) Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia (Keijzers) School of Medicine, Bond University, Gold Coast, QLD, Australia (Keijzers) School of Medicine, Griffith University, Gold Coast, QLD, Australia (Macdonald, Burcham, Fatovich) Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia (Macdonald, Burcham, Fatovich) Emergency Department, Royal Perth Hospital, The University of Western Australia, Perth, WA, Australia (Udy, Bailey, Delaney) Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Udy) Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia (Arendts) School of Medicine, The University of Western Australia, Perth, WA, Australia (Bailey) Department of Medicine and Radiology, The University of Melbourne, Melbourne, VIC, Australia (Bellomo) Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia (Bellomo) School of Medicine, The University of Melbourne, Melbourne, VIC, Australia (Blecher) Emergency Department, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia (Blecher) Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia (Coggins) Emergency Medicine and Trauma, Westmead Hospital, Sydney, NSW, Australia (Delaney) Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia (Delaney) Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia (Delaney) Division of Critical Care and Trauma, The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia (Fraser, Kinnear) Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia (Fraser) Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia (Fraser) Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia (Harley) Critical Care Management Team, Queensland Children's Hospital, Brisbane, QLD, Australia (Harley) The University of Queensland, Brisbane, QLD, Australia (Jones) School of Medicine, The University of Auckland, Auckland, New Zealand (Jones) Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand (Kinnear) Emergency and Children's Services, The Prince Charles Hospital, Brisbane, QLD, Australia (Peake, Williams) Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, SA, Australia (Peake, Williams) Faculty of Health and Medical Sciences, School of Medicine, Adelaide University, Adelaide, SA, Australia (Peake, Williams) School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Taylor) Emergency Medicine Research, Austin Hospital, Melbourne, VIC, Australia (Taylor) Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia | Issue Date: | 10-Aug-2020 | Copyright year: | 2020 | Publisher: | Blackwell Publishing | Place of publication: | Australia | Publication information: | EMA - Emergency Medicine Australasia. 32 (4) (pp 586-598), 2020. Date of Publication: 01 Aug 2020. | Journal: | EMA - Emergency Medicine Australasia | Abstract: | Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Method(s): This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Result(s): A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). Conclusion(s): Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.Copyright © 2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/1742-6723.13469 | PubMed URL: | 32043315 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32043315] | ISSN: | 1742-6731 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29222 | Type: | Article | Subjects: | epinephrine/dt [Drug Therapy] priority journal prospective study *sepsis/dt [Drug Therapy] systolic blood pressure time to treatment treatment duration treatment outcome antiinfective agent/dt [Drug Therapy] dobutamine/dt [Drug Therapy] *hypertensive factor/dt [Drug Therapy] noradrenalin/dt [Drug Therapy] metaraminol/dt [Drug Therapy] adult APACHE article Australia blood pressure measurement *clinical practice clinical trial diastolic blood pressure *emergency care female *fluid therapy hemodynamic monitoring hospital admission hospital mortality human *hypotension/dt [Drug Therapy] intensive care unit length of stay major clinical study male multicenter study New Zealand observational study outcome assessment *practice guideline epinephrine sepsis systolic blood pressure time to treatment antiinfective agent dobutamine hypertensive factor noradrenalin metaraminol APACHE Australia blood pressure measurement clinical practice diastolic blood pressure emergency care fluid therapy hemodynamic monitoring hospital admission hospital hypotension intensive care unit length of stay New Zealand practice guideline observational study prospective study *sepsis / *drug therapy systolic blood pressure time to treatment treatment duration treatment outcome adult APACHE Article Australia blood pressure measurement *clinical practice clinical trial diastolic blood pressure *emergency care female *fluid therapy hemodynamic monitoring hospital admission hospital mortality human *hypotension / *drug therapy intensive care unit length of stay major clinical study male multicenter study New Zealand outcome assessment *practice guideline priority journal |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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