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

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.

High-Intensity Resistance Training Does Not Produce Immediate Ultrasonographic Changes in Muscle Tendons.

BACKGROUND: Chronic overload injuries to tendons can be visualized using ultrasonography, with characteristics such as tendon thickening and darkening. PURPOSE: To investigate whether these characteristics are evident in the patellar and Achilles tendons immediately after 1 session of high-intensity resistance training. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 18 volunteers were randomized to an experimental group (n = 10) and a sham group (n = 8). The experimental group performed 5 circuits at maximum effort consisting of 5 weighted front squats, 10 box jumps (60/50 cm), and 15 double-under jump-rope jumps. The sham group performed a similar circuit consisting of 5 weighted shoulder presses, 10 push-ups, and 15 weighted biceps curls. Ultrasonograms were obtained before and after exercise, for a total of 30 minutes at intervals of 2.5 minutes for the first 10 minutes and 5 minutes for the remaining time. Tendon thickness and tendon matrix signals were measured. Statistics were performed using repeated-measures mixed analysis of variance (ANOVA). RESULTS: Tendon thickness did not increase significantly over 30 minutes after both circuits. The mean grayscale value for the patellar and Achilles tendons increased for both the experimental and the sham groups. ANOVA showed that the experimental group was not a significant explanatory variable; however, the increased work of both groups was. A post hoc analysis found that the maximum increase in the tendon signal was a grayscale value of 10.8 for the patellar tendon (99.4% CI, 3.7-17.9; P = .002). CONCLUSION: This trial failed to reproduce an earlier study in which tendon thickness increased after high-intensity training. The tendons produced a hyperechoic signal after high-intensity resistance training, regardless of loading to the tendon. Chronic overload characteristics on ultrasonography were not evident immediately after acute loading of tendons. CLINICAL RELEVANCE: There is a need for prognostic and diagnostic markers of tendinopathy especially because of the protracted course of subclinical development of an injury. This study assessed whether clinical findings for a chronic overload injury can be detected during acute overloading.