Se her en video om baggrunden og baggrundslitteraturen for studiet REFACED Sepsis.
Op mod 45 % af alle patienter, der indlægges via akutmodtagelserne i Danmark, har mistænkt infektion [1]. 7-26 % af patienter med mistænkt infektion og sepsis i akutmodtagelsen får sygdomsforværring [2-5] og 10-23% dør [6-8]. Hurtig og korrekt behandling er derfor vigtig. Væskebehandling er traditionelt set blevet betragtet som en vigtig del af behandlingen [9, 10], selvom fysiologien er meget dårligt belyst [8, 11-20]. Viden om væskebehandling af sepsispatienter uden shock bliver efterspurgt internationalt [21, 22]. Studier i septisk shock/hypotension, antyder en mulig fordel af at begrænse væskemængden til patienterne, men om dette også gør sig gældende for sepsis-patienter uden shock, er uvist. Dette “feasibility”-studie, ønsker at undersøge, om man ved brug af en restriktiv protokol kan nedsætte væskemængden i fht vanlig behandling. Såfremt man kan dette, vil et større randomiseret studie skulle bekræfte om det er gavnligt for patienterne.
Baggrundslitteratur
1. Henriksen DP, Laursen CB, Jensen TG, Hallas J, Pedersen C, Lassen AT: Incidence rate of community-acquired sepsis among hospitalized acute medical patients-a population-based survey. Crit Care Med 2015, 43(1):13-21.
2. Capp R, Horton CL, Takhar SS, Ginde AA, Peak DA, Zane R, Marill KA: Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival. Crit Care Med 2015, 43(5):983-988.
3. Glickman SW, Cairns CB, Otero RM, Woods CW, Tsalik EL, Langley RJ, van Velkinburgh JC, Park LP, Glickman LT, Fowler VG, Jr. et al: Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis. Acad Emerg Med 2010, 17(4):383-390.
4. Arnold RC, Sherwin R, Shapiro NI, O’Connor JL, Glaspey L, Singh S, Medado P, Trzeciak S, Jones AE: Multicenter observational study of the development of progressive organ dysfunction and therapeutic interventions in normotensive sepsis patients in the emergency department. Acad Emerg Med 2013, 20(5):433-440.
5. Jessen MK, Mackenhauer J, Hvass AM, Heide-Jorgensen U, Christiansen CF, Kirkegaard H: Predictors of intensive care unit transfer or death in emergency department patients with suspected infection. Eur J Emerg Med 2015, 22(3):176-180.
6. Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E: Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level. Crit Care Med 2018.
7. Whiles BB, Deis AS, Simpson SQ: Increased Time to Initial Antimicrobial Administration Is Associated With Progression to Septic Shock in Severe Sepsis Patients. Crit Care Med 2017, 45(4):623-629.
8. Marik PE, Linde-Zwirble WT, Bittner EA, Sahatjian J, Hansell D: Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med 2017, 43(5):625-632.
9. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME et al: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017, 45(3):486-552.
10. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM et al: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004, 32(3):858-873.
11. Ueyama H, Kiyonaka S: Predicting the Need for Fluid Therapy-Does Fluid Responsiveness Work? Journal of intensive care 2017, 5:34.
12. Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N: Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 2014, 46(5):361-380.
13. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, Lemeshow S, Osborn T, Terry KM, Levy MM: Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med 2017, 376(23):2235-2244.
14. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA: Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011, 39(2):259-265.
15. Kelm DJ, Perrin JT, Cartin-Ceba R, Gajic O, Schenck L, Kennedy CC: Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock (Augusta, Ga) 2015, 43(1):68-73.
16. Wu X, Hu Z, Yuan H, Chen L, Li Y, Zhao C: Fluid Resuscitation and Markers of Glycocalyx Degradation in Severe Sepsis. Open Med (Wars) 2017, 12:409-416.
17. Malbrain M, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, Teboul JL, Rice TW, Mythen M, Monnet X: Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Ann Intensive Care 2018, 8.
18. Sethi M, Owyang CG, Meyers C, Parekh R, Shah KH, Manini AF: Choice of resuscitative fluids and mortality in emergency department patients with sepsis. Am J Emerg Med 2018, 36(4):625-629.
19. Shaw AD, Raghunathan K, Peyerl FW, Munson SH, Paluszkiewicz SM, Schermer CR: Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Intensive Care Med 2014, 40(12):1897-1905.
20. Byrne L, Obonyo NG, Diab SD, Dunster KR, Passmore MR, Boon AC, Hoe LS, Pedersen S, Fauzi MH, Pimenta LP et al: Unintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of Endotoxemia. American journal of respiratory and critical care medicine 2018, 198(8):1043-1054.
21. Harris T, Coats TJ, Elwan MH: Fluid therapy in the emergency department: an expert practice review. Emergency medicine journal : EMJ 2018, 35(8):511-515.
22. Perner A, Gordon AC, Angus DC, Lamontagne F, Machado F, Russell JA, Timsit JF, Marshall JC, Myburgh J, Shankar-Hari M et al: The intensive care medicine research agenda on septic shock. Intensive Care Med 2017, 43(9):1294-1305.