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
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 presen...
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| Veröffentlicht in: | Emergency medicine Australasia 2020-08, Vol.32 (4), p.586-598 |
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| creator | Keijzers, Gerben Macdonald, Stephen PJ Udy, Andrew A Arendts, Glenn Bailey, Michael Bellomo, Rinaldo Blecher, Gabriel E Delaney, Anthony Fatovich, Daniel M Fraser, John F Harley, Amanda Jones, Peter Kinnear, Frances B May, Katya Peake, Sandra Taylor, David McD Nguyen, Khanh Foong, Lai Heng Hullick, Carolyn McNulty, Richard Na, Andrew Trethewy, Christopher Lutze, Lucy Zhang, Michael Cowan, Tim Middleton, Paul Avis, Suzanne Vidler, Sam Salter, Mark Janes, Simon Delaney, Anthony Harwood, Tom Oliver, Matthew Jones, Sarah Davoren, Michael Coggins, Andrew Pradhananga, Bibhu Jones, Peter Newby, Lynette Beck, Sierra Sandleback, Brad Rabas, Sophie Song, Rima Gutenstein, Marc Munro, Andrew Connely, Michael Goodson, Jennifer Mclean, Alastair Brabyn, Christine Mukerji, Saptarshi Simmonds, Harnah Young, Paul Sugeng, Yulia Bird, Cheryl McConnell, Amanda Keijzers, Gerben Henderson, Peter Perez, Siegfried Orda, Ulrich Thom, Ogilvie Roberts, Kym Kinnear, Frances Hazelwood, Sarah Pham, Hanh Eley, Rob Livesay, Georgia Devlin, Michael Murdoch, Ian Wood, Erik Williams, Julian Brown, Nathan King, Alex Sadewasser, Jan Jones, Leonie Gangathimmaiah, Vinay Haustead, Daniel Ascencio‐Lane, Juan‐Carlos Taylor, David McD Buntine, Paul Walker, Katie Pouryahya, Pourya Crompton, Daniel Sultana, Ron Campbell, Timothy Dwyer, Rosamond Blecher, Gabriel Knott, Jonathan Mitra, Biswadev Luckhoff, Carl Young, Russel Rudling, Natalie Mukherjee, Ashes Arendts, Glenn Nagree, Yusuf Koay, Keng Kruger, Coert Ghedina, Nicole Smedley, Ben Burcham, Jonathon Hamersley, Helen |
| description | 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 |
| doi_str_mv | 10.1111/1742-6723.13469 |
| format | Article |
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Macdonald, Stephen PJ ; Udy, Andrew A ; Arendts, Glenn ; Bailey, Michael ; Bellomo, Rinaldo ; Blecher, Gabriel E ; Delaney, Anthony ; Fatovich, Daniel M ; Fraser, John F ; Harley, Amanda ; Jones, Peter ; Kinnear, Frances B ; May, Katya ; Peake, Sandra ; Taylor, David McD ; Nguyen, Khanh ; Foong, Lai Heng ; Hullick, Carolyn ; McNulty, Richard ; Na, Andrew ; Trethewy, Christopher ; Lutze, Lucy ; Zhang, Michael ; Cowan, Tim ; Middleton, Paul ; Avis, Suzanne ; Vidler, Sam ; Salter, Mark ; Janes, Simon ; Delaney, Anthony ; Harwood, Tom ; Oliver, Matthew ; Jones, Sarah ; Davoren, Michael ; Coggins, Andrew ; Pradhananga, Bibhu ; Jones, Peter ; Newby, Lynette ; Beck, Sierra ; Sandleback, Brad ; Rabas, Sophie ; Song, Rima ; Gutenstein, Marc ; Munro, Andrew ; Connely, Michael ; Goodson, Jennifer ; Mclean, Alastair ; Brabyn, Christine ; Mukerji, Saptarshi ; Simmonds, Harnah ; Young, Paul ; Sugeng, Yulia ; Bird, Cheryl ; McConnell, Amanda ; Keijzers, Gerben ; Henderson, Peter ; Perez, Siegfried ; Orda, Ulrich ; Thom, Ogilvie ; Roberts, Kym ; Kinnear, Frances ; Hazelwood, Sarah ; Pham, Hanh ; Eley, Rob ; Livesay, Georgia ; Devlin, Michael ; Murdoch, Ian ; Wood, Erik ; Williams, Julian ; Brown, Nathan ; King, Alex ; Sadewasser, Jan ; Jones, Leonie ; Gangathimmaiah, Vinay ; Haustead, Daniel ; Ascencio‐Lane, Juan‐Carlos ; Taylor, David McD ; Buntine, Paul ; Walker, Katie ; Pouryahya, Pourya ; Crompton, Daniel ; Sultana, Ron ; Campbell, Timothy ; Dwyer, Rosamond ; Blecher, Gabriel ; Knott, Jonathan ; Mitra, Biswadev ; Luckhoff, Carl ; Young, Russel ; Rudling, Natalie ; Mukherjee, Ashes ; Arendts, Glenn ; Nagree, Yusuf ; Koay, Keng ; Kruger, Coert ; Ghedina, Nicole ; Smedley, Ben ; Burcham, Jonathon ; Hamersley, Helen</creator><creatorcontrib>Keijzers, Gerben ; Macdonald, Stephen PJ ; Udy, Andrew A ; Arendts, Glenn ; Bailey, Michael ; Bellomo, Rinaldo ; Blecher, Gabriel E ; Delaney, Anthony ; Fatovich, Daniel M ; Fraser, John F ; Harley, Amanda ; Jones, Peter ; Kinnear, Frances B ; May, Katya ; Peake, Sandra ; Taylor, David McD ; Nguyen, Khanh ; Foong, Lai Heng ; Hullick, Carolyn ; McNulty, Richard ; Na, Andrew ; Trethewy, Christopher ; Lutze, Lucy ; Zhang, Michael ; Cowan, Tim ; Middleton, Paul ; Avis, Suzanne ; Vidler, Sam ; Salter, Mark ; Janes, Simon ; Delaney, Anthony ; Harwood, Tom ; Oliver, Matthew ; Jones, Sarah ; Davoren, Michael ; Coggins, Andrew ; Pradhananga, Bibhu ; Jones, Peter ; Newby, Lynette ; Beck, Sierra ; Sandleback, Brad ; Rabas, Sophie ; Song, Rima ; Gutenstein, Marc ; Munro, Andrew ; Connely, Michael ; Goodson, Jennifer ; Mclean, Alastair ; Brabyn, Christine ; Mukerji, Saptarshi ; Simmonds, Harnah ; Young, Paul ; Sugeng, Yulia ; Bird, Cheryl ; McConnell, Amanda ; Keijzers, Gerben ; Henderson, Peter ; Perez, Siegfried ; Orda, Ulrich ; Thom, Ogilvie ; Roberts, Kym ; Kinnear, Frances ; Hazelwood, Sarah ; Pham, Hanh ; Eley, Rob ; Livesay, Georgia ; Devlin, Michael ; Murdoch, Ian ; Wood, Erik ; Williams, Julian ; Brown, Nathan ; King, Alex ; Sadewasser, Jan ; Jones, Leonie ; Gangathimmaiah, Vinay ; Haustead, Daniel ; Ascencio‐Lane, Juan‐Carlos ; Taylor, David McD ; Buntine, Paul ; Walker, Katie ; Pouryahya, Pourya ; Crompton, Daniel ; Sultana, Ron ; Campbell, Timothy ; Dwyer, Rosamond ; Blecher, Gabriel ; Knott, Jonathan ; Mitra, Biswadev ; Luckhoff, Carl ; Young, Russel ; Rudling, Natalie ; Mukherjee, Ashes ; Arendts, Glenn ; Nagree, Yusuf ; Koay, Keng ; Kruger, Coert ; Ghedina, Nicole ; Smedley, Ben ; Burcham, Jonathon ; Hamersley, Helen ; ARISE FLUIDS Observational Study Group ; the ARISE FLUIDS Observational Study Group</creatorcontrib><description>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.</description><identifier>ISSN: 1742-6731</identifier><identifier>EISSN: 1742-6723</identifier><identifier>DOI: 10.1111/1742-6723.13469</identifier><identifier>PMID: 32043315</identifier><language>eng</language><publisher>Melbourne: Wiley Publishing Asia Pty Ltd</publisher><subject>emergency department ; fluid therapy ; hypotension ; Original Research ; sepsis ; vasopressor</subject><ispartof>Emergency medicine Australasia, 2020-08, Vol.32 (4), p.586-598</ispartof><rights>2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine</rights><rights>2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4399-723718cd58f28385054e7b1e2f2cef6031d2fef4aac224b042cd31b12f3adf6b3</citedby><cites>FETCH-LOGICAL-c4399-723718cd58f28385054e7b1e2f2cef6031d2fef4aac224b042cd31b12f3adf6b3</cites><orcidid>0000-0001-7830-7756 ; 0000-0001-9414-6905 ; 0000-0003-1100-4552 ; 0000-0001-9921-4620 ; 0000-0001-8537-2011 ; 0000-0002-1015-7146 ; 0000-0002-8986-9997 ; 0000-0002-6284-2022 ; 0000-0003-1560-1186 ; 0000-0002-5652-6920</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1742-6723.13469$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1742-6723.13469$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32043315$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keijzers, Gerben</creatorcontrib><creatorcontrib>Macdonald, Stephen PJ</creatorcontrib><creatorcontrib>Udy, Andrew A</creatorcontrib><creatorcontrib>Arendts, Glenn</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Blecher, Gabriel E</creatorcontrib><creatorcontrib>Delaney, Anthony</creatorcontrib><creatorcontrib>Fatovich, Daniel M</creatorcontrib><creatorcontrib>Fraser, John F</creatorcontrib><creatorcontrib>Harley, Amanda</creatorcontrib><creatorcontrib>Jones, Peter</creatorcontrib><creatorcontrib>Kinnear, Frances B</creatorcontrib><creatorcontrib>May, Katya</creatorcontrib><creatorcontrib>Peake, Sandra</creatorcontrib><creatorcontrib>Taylor, David McD</creatorcontrib><creatorcontrib>Nguyen, Khanh</creatorcontrib><creatorcontrib>Foong, Lai Heng</creatorcontrib><creatorcontrib>Hullick, Carolyn</creatorcontrib><creatorcontrib>McNulty, Richard</creatorcontrib><creatorcontrib>Na, Andrew</creatorcontrib><creatorcontrib>Trethewy, Christopher</creatorcontrib><creatorcontrib>Lutze, Lucy</creatorcontrib><creatorcontrib>Zhang, Michael</creatorcontrib><creatorcontrib>Cowan, Tim</creatorcontrib><creatorcontrib>Middleton, Paul</creatorcontrib><creatorcontrib>Avis, Suzanne</creatorcontrib><creatorcontrib>Vidler, Sam</creatorcontrib><creatorcontrib>Salter, Mark</creatorcontrib><creatorcontrib>Janes, Simon</creatorcontrib><creatorcontrib>Delaney, Anthony</creatorcontrib><creatorcontrib>Harwood, Tom</creatorcontrib><creatorcontrib>Oliver, Matthew</creatorcontrib><creatorcontrib>Jones, Sarah</creatorcontrib><creatorcontrib>Davoren, Michael</creatorcontrib><creatorcontrib>Coggins, Andrew</creatorcontrib><creatorcontrib>Pradhananga, Bibhu</creatorcontrib><creatorcontrib>Jones, Peter</creatorcontrib><creatorcontrib>Newby, Lynette</creatorcontrib><creatorcontrib>Beck, Sierra</creatorcontrib><creatorcontrib>Sandleback, Brad</creatorcontrib><creatorcontrib>Rabas, Sophie</creatorcontrib><creatorcontrib>Song, Rima</creatorcontrib><creatorcontrib>Gutenstein, Marc</creatorcontrib><creatorcontrib>Munro, Andrew</creatorcontrib><creatorcontrib>Connely, Michael</creatorcontrib><creatorcontrib>Goodson, Jennifer</creatorcontrib><creatorcontrib>Mclean, Alastair</creatorcontrib><creatorcontrib>Brabyn, Christine</creatorcontrib><creatorcontrib>Mukerji, Saptarshi</creatorcontrib><creatorcontrib>Simmonds, Harnah</creatorcontrib><creatorcontrib>Young, Paul</creatorcontrib><creatorcontrib>Sugeng, Yulia</creatorcontrib><creatorcontrib>Bird, Cheryl</creatorcontrib><creatorcontrib>McConnell, Amanda</creatorcontrib><creatorcontrib>Keijzers, Gerben</creatorcontrib><creatorcontrib>Henderson, Peter</creatorcontrib><creatorcontrib>Perez, Siegfried</creatorcontrib><creatorcontrib>Orda, Ulrich</creatorcontrib><creatorcontrib>Thom, Ogilvie</creatorcontrib><creatorcontrib>Roberts, Kym</creatorcontrib><creatorcontrib>Kinnear, Frances</creatorcontrib><creatorcontrib>Hazelwood, Sarah</creatorcontrib><creatorcontrib>Pham, Hanh</creatorcontrib><creatorcontrib>Eley, Rob</creatorcontrib><creatorcontrib>Livesay, Georgia</creatorcontrib><creatorcontrib>Devlin, Michael</creatorcontrib><creatorcontrib>Murdoch, Ian</creatorcontrib><creatorcontrib>Wood, Erik</creatorcontrib><creatorcontrib>Williams, Julian</creatorcontrib><creatorcontrib>Brown, Nathan</creatorcontrib><creatorcontrib>King, Alex</creatorcontrib><creatorcontrib>Sadewasser, Jan</creatorcontrib><creatorcontrib>Jones, Leonie</creatorcontrib><creatorcontrib>Gangathimmaiah, Vinay</creatorcontrib><creatorcontrib>Haustead, Daniel</creatorcontrib><creatorcontrib>Ascencio‐Lane, Juan‐Carlos</creatorcontrib><creatorcontrib>Taylor, David McD</creatorcontrib><creatorcontrib>Buntine, Paul</creatorcontrib><creatorcontrib>Walker, Katie</creatorcontrib><creatorcontrib>Pouryahya, Pourya</creatorcontrib><creatorcontrib>Crompton, Daniel</creatorcontrib><creatorcontrib>Sultana, Ron</creatorcontrib><creatorcontrib>Campbell, Timothy</creatorcontrib><creatorcontrib>Dwyer, Rosamond</creatorcontrib><creatorcontrib>Blecher, Gabriel</creatorcontrib><creatorcontrib>Knott, Jonathan</creatorcontrib><creatorcontrib>Mitra, Biswadev</creatorcontrib><creatorcontrib>Luckhoff, Carl</creatorcontrib><creatorcontrib>Young, Russel</creatorcontrib><creatorcontrib>Rudling, Natalie</creatorcontrib><creatorcontrib>Mukherjee, Ashes</creatorcontrib><creatorcontrib>Arendts, Glenn</creatorcontrib><creatorcontrib>Nagree, Yusuf</creatorcontrib><creatorcontrib>Koay, Keng</creatorcontrib><creatorcontrib>Kruger, Coert</creatorcontrib><creatorcontrib>Ghedina, Nicole</creatorcontrib><creatorcontrib>Smedley, Ben</creatorcontrib><creatorcontrib>Burcham, Jonathon</creatorcontrib><creatorcontrib>Hamersley, Helen</creatorcontrib><creatorcontrib>ARISE FLUIDS Observational Study Group</creatorcontrib><creatorcontrib>the ARISE FLUIDS Observational Study Group</creatorcontrib><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</title><title>Emergency medicine Australasia</title><addtitle>Emerg Med Australas</addtitle><description>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.</description><subject>emergency department</subject><subject>fluid therapy</subject><subject>hypotension</subject><subject>Original 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Ltd</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7830-7756</orcidid><orcidid>https://orcid.org/0000-0001-9414-6905</orcidid><orcidid>https://orcid.org/0000-0003-1100-4552</orcidid><orcidid>https://orcid.org/0000-0001-9921-4620</orcidid><orcidid>https://orcid.org/0000-0001-8537-2011</orcidid><orcidid>https://orcid.org/0000-0002-1015-7146</orcidid><orcidid>https://orcid.org/0000-0002-8986-9997</orcidid><orcidid>https://orcid.org/0000-0002-6284-2022</orcidid><orcidid>https://orcid.org/0000-0003-1560-1186</orcidid><orcidid>https://orcid.org/0000-0002-5652-6920</orcidid></search><sort><creationdate>202008</creationdate><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</title><author>Keijzers, Gerben ; Macdonald, Stephen PJ ; Udy, Andrew A ; Arendts, Glenn ; Bailey, Michael ; Bellomo, Rinaldo ; Blecher, Gabriel E ; Delaney, Anthony ; Fatovich, Daniel M ; Fraser, John F ; Harley, Amanda ; Jones, Peter ; Kinnear, Frances B ; May, Katya ; Peake, Sandra ; Taylor, David McD ; Nguyen, Khanh ; Foong, Lai Heng ; Hullick, Carolyn ; McNulty, Richard ; Na, Andrew ; Trethewy, Christopher ; Lutze, Lucy ; Zhang, Michael ; Cowan, Tim ; Middleton, Paul ; Avis, Suzanne ; Vidler, Sam ; Salter, Mark ; Janes, Simon ; Delaney, Anthony ; Harwood, Tom ; Oliver, Matthew ; Jones, Sarah ; Davoren, Michael ; Coggins, Andrew ; Pradhananga, Bibhu ; Jones, Peter ; Newby, Lynette ; Beck, Sierra ; Sandleback, Brad ; Rabas, Sophie ; Song, Rima ; Gutenstein, Marc ; Munro, Andrew ; Connely, Michael ; Goodson, Jennifer ; Mclean, Alastair ; Brabyn, Christine ; Mukerji, Saptarshi ; Simmonds, Harnah ; Young, Paul ; Sugeng, Yulia ; Bird, Cheryl ; McConnell, Amanda ; Keijzers, Gerben ; Henderson, Peter ; Perez, Siegfried ; Orda, Ulrich ; Thom, Ogilvie ; Roberts, Kym ; Kinnear, Frances ; Hazelwood, Sarah ; Pham, Hanh ; Eley, Rob ; Livesay, Georgia ; Devlin, Michael ; Murdoch, Ian ; Wood, Erik ; Williams, Julian ; Brown, Nathan ; King, Alex ; Sadewasser, Jan ; Jones, Leonie ; Gangathimmaiah, Vinay ; Haustead, Daniel ; Ascencio‐Lane, Juan‐Carlos ; Taylor, David McD ; Buntine, Paul ; Walker, Katie ; Pouryahya, Pourya ; Crompton, Daniel ; Sultana, Ron ; Campbell, Timothy ; Dwyer, Rosamond ; Blecher, Gabriel ; Knott, Jonathan ; Mitra, Biswadev ; Luckhoff, Carl ; Young, Russel ; Rudling, Natalie ; Mukherjee, Ashes ; Arendts, Glenn ; Nagree, Yusuf ; Koay, Keng ; Kruger, Coert ; Ghedina, Nicole ; Smedley, Ben ; Burcham, Jonathon ; Hamersley, Helen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4399-723718cd58f28385054e7b1e2f2cef6031d2fef4aac224b042cd31b12f3adf6b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>emergency department</topic><topic>fluid therapy</topic><topic>hypotension</topic><topic>Original Research</topic><topic>sepsis</topic><topic>vasopressor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keijzers, Gerben</creatorcontrib><creatorcontrib>Macdonald, Stephen PJ</creatorcontrib><creatorcontrib>Udy, Andrew A</creatorcontrib><creatorcontrib>Arendts, Glenn</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Blecher, Gabriel E</creatorcontrib><creatorcontrib>Delaney, Anthony</creatorcontrib><creatorcontrib>Fatovich, Daniel M</creatorcontrib><creatorcontrib>Fraser, John F</creatorcontrib><creatorcontrib>Harley, Amanda</creatorcontrib><creatorcontrib>Jones, Peter</creatorcontrib><creatorcontrib>Kinnear, Frances B</creatorcontrib><creatorcontrib>May, Katya</creatorcontrib><creatorcontrib>Peake, Sandra</creatorcontrib><creatorcontrib>Taylor, David McD</creatorcontrib><creatorcontrib>Nguyen, Khanh</creatorcontrib><creatorcontrib>Foong, Lai Heng</creatorcontrib><creatorcontrib>Hullick, Carolyn</creatorcontrib><creatorcontrib>McNulty, Richard</creatorcontrib><creatorcontrib>Na, Andrew</creatorcontrib><creatorcontrib>Trethewy, Christopher</creatorcontrib><creatorcontrib>Lutze, Lucy</creatorcontrib><creatorcontrib>Zhang, Michael</creatorcontrib><creatorcontrib>Cowan, Tim</creatorcontrib><creatorcontrib>Middleton, Paul</creatorcontrib><creatorcontrib>Avis, Suzanne</creatorcontrib><creatorcontrib>Vidler, Sam</creatorcontrib><creatorcontrib>Salter, Mark</creatorcontrib><creatorcontrib>Janes, Simon</creatorcontrib><creatorcontrib>Delaney, Anthony</creatorcontrib><creatorcontrib>Harwood, Tom</creatorcontrib><creatorcontrib>Oliver, Matthew</creatorcontrib><creatorcontrib>Jones, Sarah</creatorcontrib><creatorcontrib>Davoren, Michael</creatorcontrib><creatorcontrib>Coggins, Andrew</creatorcontrib><creatorcontrib>Pradhananga, Bibhu</creatorcontrib><creatorcontrib>Jones, Peter</creatorcontrib><creatorcontrib>Newby, Lynette</creatorcontrib><creatorcontrib>Beck, Sierra</creatorcontrib><creatorcontrib>Sandleback, Brad</creatorcontrib><creatorcontrib>Rabas, Sophie</creatorcontrib><creatorcontrib>Song, Rima</creatorcontrib><creatorcontrib>Gutenstein, Marc</creatorcontrib><creatorcontrib>Munro, Andrew</creatorcontrib><creatorcontrib>Connely, Michael</creatorcontrib><creatorcontrib>Goodson, Jennifer</creatorcontrib><creatorcontrib>Mclean, Alastair</creatorcontrib><creatorcontrib>Brabyn, Christine</creatorcontrib><creatorcontrib>Mukerji, Saptarshi</creatorcontrib><creatorcontrib>Simmonds, Harnah</creatorcontrib><creatorcontrib>Young, Paul</creatorcontrib><creatorcontrib>Sugeng, Yulia</creatorcontrib><creatorcontrib>Bird, Cheryl</creatorcontrib><creatorcontrib>McConnell, Amanda</creatorcontrib><creatorcontrib>Keijzers, Gerben</creatorcontrib><creatorcontrib>Henderson, Peter</creatorcontrib><creatorcontrib>Perez, Siegfried</creatorcontrib><creatorcontrib>Orda, Ulrich</creatorcontrib><creatorcontrib>Thom, Ogilvie</creatorcontrib><creatorcontrib>Roberts, Kym</creatorcontrib><creatorcontrib>Kinnear, Frances</creatorcontrib><creatorcontrib>Hazelwood, Sarah</creatorcontrib><creatorcontrib>Pham, Hanh</creatorcontrib><creatorcontrib>Eley, Rob</creatorcontrib><creatorcontrib>Livesay, Georgia</creatorcontrib><creatorcontrib>Devlin, Michael</creatorcontrib><creatorcontrib>Murdoch, Ian</creatorcontrib><creatorcontrib>Wood, Erik</creatorcontrib><creatorcontrib>Williams, Julian</creatorcontrib><creatorcontrib>Brown, Nathan</creatorcontrib><creatorcontrib>King, Alex</creatorcontrib><creatorcontrib>Sadewasser, Jan</creatorcontrib><creatorcontrib>Jones, Leonie</creatorcontrib><creatorcontrib>Gangathimmaiah, Vinay</creatorcontrib><creatorcontrib>Haustead, Daniel</creatorcontrib><creatorcontrib>Ascencio‐Lane, Juan‐Carlos</creatorcontrib><creatorcontrib>Taylor, David McD</creatorcontrib><creatorcontrib>Buntine, Paul</creatorcontrib><creatorcontrib>Walker, Katie</creatorcontrib><creatorcontrib>Pouryahya, Pourya</creatorcontrib><creatorcontrib>Crompton, Daniel</creatorcontrib><creatorcontrib>Sultana, Ron</creatorcontrib><creatorcontrib>Campbell, Timothy</creatorcontrib><creatorcontrib>Dwyer, Rosamond</creatorcontrib><creatorcontrib>Blecher, Gabriel</creatorcontrib><creatorcontrib>Knott, Jonathan</creatorcontrib><creatorcontrib>Mitra, Biswadev</creatorcontrib><creatorcontrib>Luckhoff, Carl</creatorcontrib><creatorcontrib>Young, Russel</creatorcontrib><creatorcontrib>Rudling, Natalie</creatorcontrib><creatorcontrib>Mukherjee, Ashes</creatorcontrib><creatorcontrib>Arendts, Glenn</creatorcontrib><creatorcontrib>Nagree, Yusuf</creatorcontrib><creatorcontrib>Koay, Keng</creatorcontrib><creatorcontrib>Kruger, Coert</creatorcontrib><creatorcontrib>Ghedina, Nicole</creatorcontrib><creatorcontrib>Smedley, Ben</creatorcontrib><creatorcontrib>Burcham, Jonathon</creatorcontrib><creatorcontrib>Hamersley, Helen</creatorcontrib><creatorcontrib>ARISE FLUIDS Observational Study Group</creatorcontrib><creatorcontrib>the ARISE FLUIDS Observational Study Group</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Emergency medicine Australasia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keijzers, Gerben</au><au>Macdonald, Stephen PJ</au><au>Udy, Andrew A</au><au>Arendts, Glenn</au><au>Bailey, Michael</au><au>Bellomo, Rinaldo</au><au>Blecher, Gabriel E</au><au>Delaney, Anthony</au><au>Fatovich, Daniel M</au><au>Fraser, John F</au><au>Harley, Amanda</au><au>Jones, Peter</au><au>Kinnear, Frances B</au><au>May, Katya</au><au>Peake, Sandra</au><au>Taylor, David McD</au><au>Nguyen, Khanh</au><au>Foong, Lai Heng</au><au>Hullick, Carolyn</au><au>McNulty, Richard</au><au>Na, Andrew</au><au>Trethewy, Christopher</au><au>Lutze, Lucy</au><au>Zhang, Michael</au><au>Cowan, Tim</au><au>Middleton, Paul</au><au>Avis, Suzanne</au><au>Vidler, Sam</au><au>Salter, Mark</au><au>Janes, Simon</au><au>Delaney, Anthony</au><au>Harwood, Tom</au><au>Oliver, Matthew</au><au>Jones, Sarah</au><au>Davoren, Michael</au><au>Coggins, Andrew</au><au>Pradhananga, Bibhu</au><au>Jones, Peter</au><au>Newby, Lynette</au><au>Beck, Sierra</au><au>Sandleback, Brad</au><au>Rabas, Sophie</au><au>Song, Rima</au><au>Gutenstein, Marc</au><au>Munro, Andrew</au><au>Connely, Michael</au><au>Goodson, Jennifer</au><au>Mclean, Alastair</au><au>Brabyn, Christine</au><au>Mukerji, Saptarshi</au><au>Simmonds, Harnah</au><au>Young, Paul</au><au>Sugeng, Yulia</au><au>Bird, Cheryl</au><au>McConnell, Amanda</au><au>Keijzers, Gerben</au><au>Henderson, Peter</au><au>Perez, Siegfried</au><au>Orda, Ulrich</au><au>Thom, Ogilvie</au><au>Roberts, Kym</au><au>Kinnear, Frances</au><au>Hazelwood, Sarah</au><au>Pham, Hanh</au><au>Eley, Rob</au><au>Livesay, Georgia</au><au>Devlin, Michael</au><au>Murdoch, Ian</au><au>Wood, Erik</au><au>Williams, Julian</au><au>Brown, Nathan</au><au>King, Alex</au><au>Sadewasser, Jan</au><au>Jones, Leonie</au><au>Gangathimmaiah, Vinay</au><au>Haustead, Daniel</au><au>Ascencio‐Lane, Juan‐Carlos</au><au>Taylor, David McD</au><au>Buntine, Paul</au><au>Walker, Katie</au><au>Pouryahya, Pourya</au><au>Crompton, Daniel</au><au>Sultana, Ron</au><au>Campbell, Timothy</au><au>Dwyer, Rosamond</au><au>Blecher, Gabriel</au><au>Knott, Jonathan</au><au>Mitra, Biswadev</au><au>Luckhoff, Carl</au><au>Young, Russel</au><au>Rudling, Natalie</au><au>Mukherjee, Ashes</au><au>Arendts, Glenn</au><au>Nagree, Yusuf</au><au>Koay, Keng</au><au>Kruger, Coert</au><au>Ghedina, Nicole</au><au>Smedley, Ben</au><au>Burcham, Jonathon</au><au>Hamersley, Helen</au><aucorp>ARISE FLUIDS Observational Study Group</aucorp><aucorp>the ARISE FLUIDS Observational Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Emergency medicine Australasia</jtitle><addtitle>Emerg Med Australas</addtitle><date>2020-08</date><risdate>2020</risdate><volume>32</volume><issue>4</issue><spage>586</spage><epage>598</epage><pages>586-598</pages><issn>1742-6731</issn><eissn>1742-6723</eissn><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.</abstract><cop>Melbourne</cop><pub>Wiley Publishing Asia Pty Ltd</pub><pmid>32043315</pmid><doi>10.1111/1742-6723.13469</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-7830-7756</orcidid><orcidid>https://orcid.org/0000-0001-9414-6905</orcidid><orcidid>https://orcid.org/0000-0003-1100-4552</orcidid><orcidid>https://orcid.org/0000-0001-9921-4620</orcidid><orcidid>https://orcid.org/0000-0001-8537-2011</orcidid><orcidid>https://orcid.org/0000-0002-1015-7146</orcidid><orcidid>https://orcid.org/0000-0002-8986-9997</orcidid><orcidid>https://orcid.org/0000-0002-6284-2022</orcidid><orcidid>https://orcid.org/0000-0003-1560-1186</orcidid><orcidid>https://orcid.org/0000-0002-5652-6920</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1742-6731 |
| ispartof | Emergency medicine Australasia, 2020-08, Vol.32 (4), p.586-598 |
| issn | 1742-6731 1742-6723 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7496107 |
| source | Wiley Online Library Journals Frontfile Complete |
| subjects | emergency department fluid therapy hypotension Original Research sepsis vasopressor |
| 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 |
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