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Mortality benefit of crystalloids administered in 1-6 hours in septic adults in the ED: Systematic review with narrative synthesis

Citation

Xantus, GZ and Allen, P and Norman, S and Kanizsai, PL, Mortality benefit of crystalloids administered in 1-6 hours in septic adults in the ED: Systematic review with narrative synthesis, Emergency Medicine Journal, 38, (6) pp. 430-438. ISSN 1472-0205 (2021) [Refereed Article]


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DOI: doi:10.1136/emermed-2020-210298

Abstract

Background: Based on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the NHSs of England recommended the instigation of the elements of the 'Sepsis-6 bundle' within 1 hour to adult patients screened positive for sepsis. This bundle includes a bolus infusion of 30 mL/kg crystalloids in the ED. Besides the UK, both in the USA and Australia, compliance with similar 1-hour targets became an important quality indicator. However, the supporting evidence may neither be contemporaneous nor necessarily valid for emergency medicine settings.

Method: A systematic review was designed and registered at PROSPERO to assess available emergency medicine/prehospital evidence published between 2012 and 2020, investigating the clinical benefits associated with a bolus infusion of a minimum 30 mL/kg crystalloids within 1 hour to adult patients screened positive for sepsis. Due to the small number of papers that addressed this volume of fluids in 1 hour, we expanded the search to include studies looking at 1-6 hours.

Results: Seven full-text articles were identified, which investigated various aspects of the fluid resuscitation in adult sepsis. However, none answered completely to the original research question aimed to determine either the effect of time-to-crystalloids or the optimal fluid volume of resuscitation. Our findings demonstrated that in the USA/UK/Australia/Canada, adult ED septic patients receive 23-43 mL/kg of crystalloids during the first 6 hours of resuscitation without significant differences either in mortality or in adverse effects.

Conclusion: This systematic review did not find high-quality evidence supporting the administration of 30 mL/kg crystalloid bolus to adult septic patients within 1 hour of presentation in the ED. Future research must investigate both the benefits and the potential harms of the recommended intervention.

Item Details

Item Type:Refereed Article
Keywords:acute care, clinical management, death/mortality
Research Division:Health Sciences
Research Group:Nursing
Research Field:Acute care
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Allen, P (Dr Penny Allen)
ID Code:146391
Year Published:2021
Deposited By:Rural Clinical School
Deposited On:2021-09-03
Last Modified:2021-09-03
Downloads:0

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