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Observational Study
. 2021 Sep;65(8):1122-1142.
doi: 10.1111/aas.13848. Epub 2021 May 18.

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

Marie K Jessen  1   2 , Lars W Andersen  1   3   4 , Marie-Louise H Thomsen  1   2 , Marie E Jensen  1 , Mathilde E Kirk  1 , Sofie Kildegaard  5   6 , Poul Petersen  7 , Rajesh Mohey  8 , Anders H Madsen  9 , Anders Perner  10 , Jens Aage Kølsen Petersen  3 , Hans Kirkegaard  1   2   4
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Observational Study

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

Marie K Jessen et al. Acta Anaesthesiol Scand. 2021 Sep.

Abstract

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.

Keywords: emergency department; infection; sepsis; fluid therapy.

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References

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