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Non-Invasive Cardiac Output Monitoring in Sepsis – Fluid Responsiveness in the Emergency Department

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Fluid Responsiveness in Emergency Department Sepsis Patients

Ignacio Salas1,2, Eliot Williams2, Tim Harris2

1University of California, San Francisco,  2  Barts Health Trust,  London, UK

 

Introduction

•Sepsis and septic shock are significant healthcare problems in the emergency department (ED), with yearly worldwide incidence of 19 million (Adhikari et al. Lancet (2010))
•Intravenous fluid administration remains a key component in the early management of sepsis
•Intravascular volume expansion with fluids aims to increase tissue perfusion by increasing cardiac output
•Both under and over fluid administration are associated with negative outcomes

 

Material and Methods

Design: Prospective observational study in two urban hospitals [London, UK]

Inclusion criteria

•Age > 18 years
•Suspected infection with two or more Systemic Inflammatory Response Syndrome (SIRS) criteria
•Fluid bolus prescribed

Device: Bioreactance monitor (Cheetah Medical, Tel Aviv, Israel)

Primary outcomes: Continuous stroke volume index measurements of pre and post fluid bolus

Results (Cont.)

 

Conclusion

•Fluid bolus physiology is unknown in the emergency department
•This study suggests that about 50% patients respond to a fluid bolus
•This is consistent with ICU literature (Bentzer et al. JAMA (2016))
•Fluid response is not sustained with time

Limitations

•Small population
•Observational study
•Many patients in cohort were not in shock

 

 

 

 

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