Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/19898
Title: Restricted fluid resuscitation in suspected sepsis associated hypotension (REFRESH): a pilot randomised controlled trial.
Authors: Macdonald, Stephen P J;Keijzers, Gerben;Taylor, David McD;Kinnear, Frances;Arendts, Glenn;Fatovich, Daniel M;Bellomo, Rinaldo;McCutcheon, David;Fraser, John F;Ascencio-Lane, Juan-Carlos;Burrows, Sally;Litton, Edward;Harley, Amanda;Anstey, Matthew;Mukherjee, Ashes
Affiliation: Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, Australia
Emergency Department, Royal Hobart Hospital, Hobart, Australia
Department of Intensive Care, Fiona Stanley Hospital, Perth, Australia
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
Emergency Department, Gold Coast University Hospital, Gold Coast, Australia
School of Medicine, Bond University, Gold Coast, Australia
School of Medical Sciences, Griffith University, Gold Coast, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia
Emergency Department, The Prince Charles Hospital, Brisbane, Australia
Medical School, University of Western Australia, Perth, Australia
Emergency Department, Fiona Stanley Hospital, Perth, Australia
Emergency Department, Royal Perth Hospital, Perth, WA, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Emergency Department, Armadale-Kelmscott Memorial Hospital, Perth, Australia
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
Issue Date: 31-Oct-2018
EDate: 2018-10-31
Citation: Intensive care medicine 2018; online first: 31 October
Abstract: 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. 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. 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. 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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/19898
DOI: 10.1007/s00134-018-5433-0
ORCID: 0000-0002-8986-9997
0000-0002-1650-8939
PubMed URL: 30382308
Type: Journal Article
Subjects: Critical care
Emergency medicine
Fluid therapy
Resuscitation
Sepsis
Septic shock
Appears in Collections:Journal articles

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