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Primary fluid bolus therapy for infection-associated hypotension in the emergency department
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
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2015 (English)In: CRITICAL CARE AND RESUSCITATION, ISSN 1441-2772, Vol. 17, no 1, 6-11 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The physiological changes associated with fluid bolus therapy (FBI) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. Methods: We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP) <100 mmHg who underwent FBI in the first 6 hours. Results: We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBI volume given was 1570 mL (interquartile range, 1000 2490 mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66 mmHg [SD, 10 mmHg]) to its value at 6 hours (73 mmHg [SD, 12 mmHg]; P < 0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P < 0.05). In patients who were severely hypotensive (SBP <90 mmHg) on arrival at the ED, the MAP increased from 54 mmHg (SD, 8 mmHg) to 70 mmHg (SD, 14 mmHg) (P < 0.001). At 6 hours, however, SBP was still <100 mmHg in 44 patients and <90 mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58 mmHg (SD, 9 mmHg) to 75 mmHg (SD, 13 mmHg). Conclusion: Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of > 100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.

Place, publisher, year, edition, pages
2015. Vol. 17, no 1, 6-11 p.
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Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-248440ISI: 000349934300002PubMedID: 25702756OAI: oai:DiVA.org:uu-248440DiVA: diva2:800291
Available from: 2015-04-02 Created: 2015-03-30 Last updated: 2015-04-02Bibliographically approved

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