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

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.