Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22611
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: Keijzers, Gerben;Macdonald, Stephen Pj;Udy, Andrew A;Arendts, Glenn;Bailey, Michael;Bellomo, Rinaldo;Blecher, Gabriel E;Burcham, Jonathon;Coggins, Andrew R;Delaney, Anthony;Fatovich, Daniel M;Fraser, John F;Harley, Amanda;Jones, Peter;Kinnear, Frances B;May, Katya;Peake, Sandra;Taylor, David McD;Williams, Patricia
Affiliation: Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
Critical Care Management Team, Queensland Children's Hospital, Brisbane, Queensland, Australia
The University of Queensland, Brisbane, Queensland, Australia
Emergency and Children's Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
Faculty of Health and Medical Sciences, School of Medicine, Adelaide University, Adelaide, South Australia, Australia
School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Emergency Medicine Research, Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Medicine, The University of Auckland, Auckland, New Zealand
Emergency Medicine and Trauma, Westmead Hospital, Sydney, New South Wales, Australia
Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
School of Medicine, Bond University, Gold Coast, Queensland, Australia
School of Medicine, Griffith University, Gold Coast, Queensland, Australia
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Emergency Department, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
Department of Medicine and Radiology, The University of Melbourne, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
Division of Critical Care and Trauma, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
Issue Date: 10-Feb-2020
EDate: 2020-02-10
Citation: Emergency medicine Australasia : EMA 2020; online first: 10 February
Abstract: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. 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. 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%). 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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22611
DOI: 10.1111/1742-6723.13469
ORCID: 0000-0003-1100-4552
0000-0001-9921-4620
0000-0002-6284-2022
0000-0001-7830-7756
0000-0001-8537-2011
0000-0002-5652-6920
0000-0002-1015-7146
0000-0001-9414-6905
0000-0003-1560-1186
0000-0002-8986-9997
0000-0002-1650-8939
PubMed URL: 32043315
Type: Journal Article
Subjects: emergency department
fluid therapy
hypotension
sepsis
vasopressor
Appears in Collections:Journal articles

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