24-hour fluid administration in emergency department patients with suspected infection; a multicenter, prospective, observational study.

Jessen, Marie Kristine; Andersen, Lars Wiuff; Thomsen, Marie-Louise Holm; Jensen, Marie Egebjerg; Kirk, Mathilde Emilie; Kildegaard, Sofie; Petersen, Poul; Mohey, Rajesh; Madsen, Anders Husted; Perner, Anders; Kølsen Petersen, Jens Aage; Kirkegaard, Hans

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-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, 8 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): 60-79years: -470ml (95%CI:-789;-150), 80+years; -974ml (95%CI:-1307;-640)), do-not-resuscitate-orders (MD: -466ml (95%CI:-797;-135)), and preexisting atrial fibrillation (MD: -367ml (95%CI: -661;-72)) were associated with less fluid. Systolic blood pressure<100 mmHg (MD: 1182ml (95%CI:820;1543)), mean arterial pressure<65mmHg (MD: 1317ml (95%CI:770;1864)), lactate≥2mmol/l (MD: 655ml (95%CI:306;1005)), heart rate>120min-1 (MD: 566 (95%CI:169;962)), low (MD: 1963ml (95%CI: 813;3112)) and high temperature (MD: 489ml (95%CI: 234;742)), SOFA-score>5 (MD: 1005ml (95%CI: 501; 510), and new-onset atrial fibrillation (MD: 498ml (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.