Projects per year
Abstract
INTRODUCTION: To describe the utilization of vasopressors (VP) in patients enrolled in the Australasian Resuscitation In Sepsis Evaluation (ARISE) trial, and to explore the association between time to VP and 90-day mortality. METHODS: The primary exposure variable was VP use after arrival in the emergency department (ED). Vasoactive agents considered as VP included: norepinephrine, epinephrine, metaraminol, or vasopressin. Time-to-event analysis, multivariable logistic regression, and propensity-matched treatment effects modeling were used to assess the association between time to VP and 90-day mortality. RESULTS: In total 1,102 of 1,588 patients (69%) in ARISE received VP at any point. The median [interquartile range (IQR)] time from ED presentation to commencing VP was 4.4 [2.7, 7.1] h, and 38% did so prior to central venous access. The median [IQR] volume of intravenous (i.v.) fluid administered prior to commencing VP was 3.1 [2.3, 4.3] L. Increasing age and volume of i.v. fluid therapy were associated with a lower likelihood of commencing VP early (within 4 h of ED presentation), while greater illness severity was associated with a higher likelihood, P < 0.001, respectively. In those who subsequently died within 90 days, the sub-hazard ratio (95% confidence interval) for commencing VP was 1.4 (1.20, 1.68), P < 0.001, adjusted for age, acute physiology and chronic health evaluation II score, study group, inclusion criteria, plasma lactate, i.v. fluid prior to VP, study institution, and site of infection. DISCUSSION: 50% of the ARISE cohort commenced VP within 4.4 h of ED presentation, and many did so prior to central venous access. Earlier initiation of VP was associated with greater crude and adjusted 90-day mortality.
Original language | English |
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Pages (from-to) | 400-407 |
Number of pages | 8 |
Journal | Shock |
Volume | 52 |
Issue number | 4 |
DOIs | |
Publication status | Published - Oct 2019 |
Keywords
- Epidemiology
- mortality
- septic shock
- severe sepsis
- vasopressors
Projects
- 2 Finished
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The Australasian Resuscitation in Sepsis Evaluation - Randomised Controlled Trial - continuation funding request
Bellomo, R., Cameron, P., Cooper, J., Delaney, A., Holdgate, A., Peake, S. L. & Webb, S. A. R.
National Health and Medical Research Council (NHMRC) (Australia)
1/01/12 → 31/12/14
Project: Research
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The Australiasian Resuscitation in Sepsis Evaluation - Randomised Controlled Trail
Bellomo, R., Cameron, P., Cooper, J., Delaney, A., Peake, S. L. & Webb, S. A. R.
National Health and Medical Research Council (NHMRC) (Australia)
2/01/08 → 31/12/14
Project: Research