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.

Abstract

OBJECTIVES:

To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension.

METHODS:

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.

RESULTS:

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:

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.

• Authors: Gerben Keijzers, Stephen Pj Macdonald, Andrew A Udy, Glenn Arendts, Michael Bailey, Rinaldo Bellomo, Gabriel E Blecher, Jonathon Burcham, Andrew R Coggins, Anthony Delaney, Daniel M Fatovich, John F Fraser, Amanda Harley, Peter Jones, Frances B Kinnear, Katya May, Sandra Peake, David McD Taylor, Patricia Williams, the ARISE FLUIDS Observational Study Group
• Journal: Emergency medicine Australasia : EMA (Emerg Med Australas) Vol. 32 Issue 4 Pg. 586-598 (08 2020) ISSN: 1742-6723 [Electronic] Australia
• PMID: 32043315 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

Topics

• Adult
• Australia
• Emergency Service, Hospital
• Fluid Therapy
• Humans
• Middle Aged
• New Zealand
• Prospective Studies
• Resuscitation
• Sepsis (diagnosis, drug therapy)
• Shock, Septic (diagnosis, drug therapy)