Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/19898
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dc.contributor.authorMacdonald, Stephen P J-
dc.contributor.authorKeijzers, Gerben-
dc.contributor.authorTaylor, David McD-
dc.contributor.authorKinnear, Frances-
dc.contributor.authorArendts, Glenn-
dc.contributor.authorFatovich, Daniel M-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorMcCutcheon, David-
dc.contributor.authorFraser, John F-
dc.contributor.authorAscencio-Lane, Juan-Carlos-
dc.contributor.authorBurrows, Sally-
dc.contributor.authorLitton, Edward-
dc.contributor.authorHarley, Amanda-
dc.contributor.authorAnstey, Matthew-
dc.contributor.authorMukherjee, Ashes-
dc.date2018-10-31-
dc.date.accessioned2018-11-26T00:51:16Z-
dc.date.available2018-11-26T00:51:16Z-
dc.date.issued2018-10-31-
dc.identifier.citationIntensive care medicine 2018; online first: 31 October-
dc.identifier.urihttp://ahro.austin.org.au/austinjspui/handle/1/19898-
dc.description.abstractTo 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.-
dc.language.isoeng-
dc.subjectCritical care-
dc.subjectEmergency medicine-
dc.subjectFluid therapy-
dc.subjectResuscitation-
dc.subjectSepsis-
dc.subjectSeptic shock-
dc.titleRestricted fluid resuscitation in suspected sepsis associated hypotension (REFRESH): a pilot randomised controlled trial.-
dc.typeJournal Article-
dc.identifier.journaltitleIntensive care medicine-
dc.identifier.affiliationDepartment of Intensive Care, Sir Charles Gairdner Hospital, Perth, Australiaen
dc.identifier.affiliationEmergency Department, Royal Hobart Hospital, Hobart, Australiaen
dc.identifier.affiliationDepartment of Intensive Care, Fiona Stanley Hospital, Perth, Australiaen
dc.identifier.affiliationCentre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australiaen
dc.identifier.affiliationEmergency Department, Gold Coast University Hospital, Gold Coast, Australiaen
dc.identifier.affiliationSchool of Medicine, Bond University, Gold Coast, Australiaen
dc.identifier.affiliationSchool of Medical Sciences, Griffith University, Gold Coast, Australiaen
dc.identifier.affiliationDepartment of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australiaen
dc.identifier.affiliationDepartment of Medicine, University of Melbourne, Melbourne, Australiaen
dc.identifier.affiliationEmergency Department, The Prince Charles Hospital, Brisbane, Australiaen
dc.identifier.affiliationMedical School, University of Western Australia, Perth, Australiaen
dc.identifier.affiliationEmergency Department, Fiona Stanley Hospital, Perth, Australiaen
dc.identifier.affiliationEmergency Department, Royal Perth Hospital, Perth, WA, Australiaen
dc.identifier.affiliationDepartment of Intensive Care, Austin Health, Heidelberg, Victoria, Australiaen
dc.identifier.affiliationEmergency Department, Armadale-Kelmscott Memorial Hospital, Perth, Australiaen
dc.identifier.affiliationCritical Care Research Group, The Prince Charles Hospital, Brisbane, Australiaen
dc.identifier.doi10.1007/s00134-018-5433-0-
dc.identifier.orcid0000-0002-8986-9997en
dc.identifier.orcid0000-0002-1650-8939en
dc.identifier.pubmedid30382308-
Appears in Collections:Journal articles

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