Résumé
Objectives: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid administered in early septic shock to inform the design of future septic shock fluid resuscitation trials. Methods: Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey. Results: A total of 1097 physicians' responses were included. 1 L was the most frequent quantity of resuscitation fluid physicians indicated they would administer at a time (46.9%, n=499). Most (63.0%, n=671) stated that they would administer the fluid challenges as quickly as possible. Overall, normal saline and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said that they would use saline 'often' or 'always' in 27.9% (n=150) of instances. Only 1.0% (n=10) of respondents indicated that they would use hydroxyethyl starch 'often' or 'always'; use of 5% (5.6% (n=59)) or 20- 25% albumin (1.3% (n=14)) was also infrequent. The majority (88.4%, n=896) of respondents indicated that a large randomised controlled trial comparing 5% albumin to a crystalloid fluid in early septic shock was important to conduct. Conclusions: Critical care and emergency physicians stated that they rapidly infuse volumes of 500-1000 mL of resuscitation fluid in early septic shock. Colloid use, specifically the use of albumin, was infrequently reported. Our survey identifies the need to conduct a trial on the efficacy of albumin and crystalloids on 90-day mortality in patients with early septic shock.
| Langue d'origine | English |
|---|---|
| Numéro d'article | e010041 |
| Journal | BMJ Open |
| Volume | 6 |
| Numéro de publication | 7 |
| DOI | |
| Statut de publication | Published - juill. 1 2016 |
Note bibliographique
Funding Information:The authors would like to acknowledge the Canadian Critical Care Society, the Intensive Care Foundation (UK), the Royal College of Emergency Medicine (UK) and the King Abdullah International Medical Research Centre for their assistance in contacting emergency and critical care physicians through their respective membership lists. BHR is supported by the Canadian Institutes of Health Research (CIHR) as a Tier I Canada Research Chair in Evidence-based Emergency Medicine through the Government of Canada (Ottawa, Ontario, Canada). AT and RZ are recipients of CIHR new investigator awards, SMB is supported by CIHR as a Tier II Canada Research Chair in Critical Care Nephrology and DC is supported by CIHR as a Tier II Canada Research Chair in Critical Care. The authors would like to thank Francois Lauzier from the Canadian Critical Care Trials Group for a critical review of this manuscript, Tinghua Zhang from the Ottawa Hospital Research Institute (OHRI) for collating the data and performing the statistical analyses, the Centre for Transfusion Research at the OHRI for their in-kind study support, and Marnie Gordon for her administrative support.
ASJC Scopus Subject Areas
- General Medicine