Jens Aage Kølsen Petersen

Twenty-four-hour fluid administration in emergency department patients with suspected infection: A multicenter, prospective, observational study

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DOI

Background: To describe 24-hour fluid administration in emergency department (ED) patients with suspected infection. Methods: A prospective, multicenter, observational study conducted in three Danish hospitals, January 20 to March 2, 2020. We included consecutive adult ED patients with suspected infection (drawing of blood culture and/or intravenous antibiotic administration within 6 hours of admission). Oral and intravenous fluids were registered for 24 hours. Primary outcome: 24-hour total fluid volume. We used linear regression to investigate patient and disease characteristics' effect on 24-hour fluids and to estimate the proportion of the variance in fluid administration explained by potential predictors. Results: 734 patients had 24-hour fluids available: 387 patients had simple infection, 339 sepsis, eight septic shock. Mean total 24-hour fluid volumes were 3656 mL (standard deviation [SD]:1675), 3762 mL (SD: 1839), and 6080 mL (SD: 3978) for the groups, respectively. Fluid volumes varied markedly. Increasing age (mean difference [MD]: 60-79 years: −470 mL [95% CI: −789, −150], +80 years; −974 mL [95% CI: −1307, −640]), do-not-resuscitate orders (MD: −466 mL [95% CI: −797, −135]), and preexisting atrial fibrillation (MD: −367 mL [95% CI: −661, −72) were associated with less fluid. Systolic blood pressure < 100 mmHg (MD: 1182 mL [95% CI: 820, 1543]), mean arterial pressure < 65 mmHg (MD: 1317 mL [95% CI: 770, 1864]), lactate ≥ 2 mmol/L (MD: 655 mL [95% CI: 306, 1005]), heart rate > 120 min (MD: 566 [95% CI: 169, 962]), low (MD: 1963 mL [95% CI: 813, 3112]) and high temperature (MD: 489 mL [95% CI: 234, 742]), SOFA score > 5 (MD: 1005 mL [95% CI: 501, 510]), and new-onset atrial fibrillation (MD: 498 mL [95% CI: 30, 965]) were associated with more fluid. Clinical variables explained 37% of fluid variation among patients. Conclusions: Patients with simple infection and sepsis received equal fluid volumes. Fluid volumes varied markedly, a variation that was partly explained by clinical characteristics.

OriginalsprogEngelsk
TidsskriftActa Anaesthesiologica Scandinavica
Vol/bind65
Nummer8
Sider (fra-til)1122-1142
Antal sider21
ISSN0001-5172
DOI
StatusUdgivet - sep. 2021

Bibliografisk note

Funding Information:
Dr Jessen reports grants from Carl and Ellen Hertz Foundation, grants from Frimodt‐Heineke Foundation, grants from Ruth & Holger Hesses Memorial Fund, grants from Aarhus University, grants from Health Research Foundation of Central Denmark Region, grants from "Akutpuljen" Central Denmark Region, during the conduct of the study. None of the above were personal and all were paid to Research Center for Emergency Medicine, Aarhus University Hospital. Dr Perner reports grants from Novo Nordisk Foundation, grants from Pfizer, Denmark, outside the submitted work.

Funding Information:
We thank all participating departments and staff for their great contribution to the study. We would also like to thank the interdisciplinary CONSIDER Sepsis Network, based at Research Center for Emergency Medicine, Aarhus University Hospital for guidance throughout the process. This study received funding from Carl and Ellen Hertz Foundation, Frimodt-Heineke Foundation, Ruth & Holger Hesses Memorial Fund, Aarhus University, ?Akutpuljen? Central Denmark Region and Health Research Foundation of Central Denmark Region.

Funding Information:
We thank all participating departments and staff for their great contribution to the study. We would also like to thank the interdisciplinary CONSIDER Sepsis Network, based at Research Center for Emergency Medicine, Aarhus University Hospital for guidance throughout the process. This study received funding from Carl and Ellen Hertz Foundation, Frimodt‐Heineke Foundation, Ruth & Holger Hesses Memorial Fund, Aarhus University, “Akutpuljen” Central Denmark Region and Health Research Foundation of Central Denmark Region.

Publisher Copyright:
© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd

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