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. (10th February 2020)

• Record Type: Journal Article
• 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
• Other Names: Nguyen Khanh investigator.; Foong Lai Heng investigator.; Hullick Carolyn investigator.; McNulty Richard investigator.; Na Andrew investigator.; Trethewy Christopher investigator.; Lutze Lucy investigator.; Zhang Michael investigator.; Cowan Tim investigator.; Middleton Paul investigator.; Avis Suzanne investigator.; Vidler Sam investigator.; Salter Mark investigator.; Janes Simon investigator.; Delaney Anthony investigator.; Harwood Tom investigator.; Oliver Matthew investigator.; Jazayeri Farzad investigator.; Jones Sarah investigator.; Davoren Michael investigator.; Coggins Andrew investigator.; Pradhananga Bibhu investigator.; Jones Peter investigator.; Newby Lynette investigator.; Beck Sierra investigator.; Sandleback Brad investigator.; Rabas Sophie investigator.; Harger Simon investigator.; Tan Eunicia investigator.; Song Rima investigator.; Gutenstein Marc investigator.; Munro Andrew investigator.; Connely Michael investigator.; Goodson Jennifer investigator.; Mclean Alastair investigator.; Brabyn Christine investigator.; Mukerji Saptarshi investigator.; Simmonds Harnah investigator.; Young Paul investigator.; Sugeng Yulia investigator.; Bird Cheryl investigator.; McConnell Amanda investigator.; Keijzers Gerben investigator.; Henderson Peter investigator.; Johnson David investigator.; Perez Siegfried investigator.; Mahani Abbas investigator.; Orda Ulrich investigator.; Thom Ogilvie investigator.; Roberts Kym investigator.; Kinnear Frances investigator.; Hazelwood Sarah investigator.; Pham Hanh investigator.; Eley Rob investigator.; Livesay Georgia investigator.; Devlin Michael investigator.; Murdoch Ian investigator.; Wood Erik investigator.; Williams Julian investigator.; Brown Nathan investigator.; King Alex investigator.; Sadewasser Jan investigator.; Jones Leonie investigator.; Gangathimmaiah Vinay investigator.; Manudhane Anit investigator.; Haustead Daniel investigator.; Ascencio‐Lane Juan‐Carlos investigator.; Taylor David McD. investigator.; Buntine Paul investigator.; Walker Katie investigator.; Pouryahya Pourya investigator.; Crompton Daniel investigator.; Sultana Ron investigator.; Campbell Timothy investigator.; Dwyer Rosamond investigator.; Blecher Gabriel investigator.; Knott Jonathan investigator.; Mitra Biswadev investigator.; Luckhoff Carl investigator.; Young Russel investigator.; Rudling Natalie investigator.; Mukherjee Ashes investigator.; Dyke Kerry‐Lee investigator.; Parker Casey investigator.; Arendts Glenn investigator.; Cooper Alannah investigator.; Nagree Yusuf investigator.; Koay Keng investigator.; Kruger Coert investigator.; Ghedina Nicole investigator.; Smedley Ben investigator.; Burcham Jonathon investigator.; Macdonald Stephen investigator.; Hamersley Helen investigator.;
• Is Part Of: Emergency medicine Australasia. Volume 32:Number 4(2020)
• Page Start: 586
• Page End: 598
• Publication Date: 2020-02-10
• Subjects: emergency department -- fluid therapy -- hypotension -- sepsis -- vasopressor; Emergency medicine -- Periodicals; Emergency medicine -- Australasia -- Periodicals; 616.025
• DOI: 10.1111/1742-6723.13469
• Languages: English
• ISSNs: 1742-6731

Abstract

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.