Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12647
Title: Primary fluid bolus therapy for infection-associated hypotension in the emergency department.
Authors: Lipcsey, Miklos;Chiong, Jonathan;Subiakto, Ivan;Kaufman, Melissa A;Schneider, Antoine G;Bellomo, Rinaldo
Affiliation: Department of Surgical Sciences, Hedenstierna Laboratory, Section of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden. rinaldo.bellomo@austin.org.au.
Department of Cardiology, Northern Hospital, Melbourne, VIC, Australia.
Department of Adult Intensive Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Issue Date: 1-Mar-2015
Citation: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine; 17(1): 6-11
Abstract: The physiological changes associated with fluid bolus therapy (FBT) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension.We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP)<100 mmHg who underwent FBT in the first 6 hours.We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBT volume given was 1570 mL (interquartile range, 1000- 2490 mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66 mmHg [SD, 10 mmHg]) to its value at 6 hours (73 mmHg [SD, 12 mmHg]; P<0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P<0.05). In patients who were severely hypotensive (SBP<90 mmHg) on arrival at the ED, the MAP increased from 54 mmHg (SD, 8 mmHg) to 70 mmHg (SD, 14 mmHg) (P<0.001). At 6 hours, however, SBP was still <100 mmHg in 44 patients and <90 mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58 mmHg (SD, 9 mmHg) to 75 mmHg (SD, 13 mmHg).Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of >100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.
Internal ID Number: 25702756
URI: http://ahro.austin.org.au/austinjspui/handle/1/12647
URL: http://www.ncbi.nlm.nih.gov/pubmed/25702756
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Emergency Service, Hospital
Female
Fluid Therapy.methods
Humans
Hypotension.etiology.therapy
Infection.complications
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Appears in Collections:Journal articles

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