Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study

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• 作者：Christopher W Seymour (1) (2)
  Colin R Cooke (3) (4)
  Susan R Heckbert (5)
  John A Spertus (6)
  Clifton W Callaway (7)
  Christian Martin-Gill (7)
  Donald M Yealy (7)
  Thomas D Rea (8) (9)
  Derek C Angus (10) (2)
  
  1. Departments of Critical Care Medicine and Emergency Medicine ; University of Pittsburgh School of Medicine ; 3550 Terrace Street ; 15261 ; Pittsburgh ; PA ; USA
  2. Clinical Research ; Investigation ; and Systems Modeling of Acute Illness (CRISMA) Center ; 3550 Terrace Street ; 15261 ; Pittsburgh ; PA ; USA
  3. Division of Pulmonary and Critical Care Medicine ; University of Michigan ; Ann Arbor ; MI ; USA
  4. Center for Healthcare Outcomes & Policy ; University of Michigan ; Ann Arbor ; MI ; USA
  5. Department of Epidemiology ; University of Washington School of Public Health ; Seattle ; WA ; USA
  6. Saint Luke鈥檚 Mid America Heart Institute ; University of Missouri-Kansas City School of Medicine ; Kansas City ; USA
  7. Department of Emergency Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh ; PA ; USA
  8. King County MedicOne ; King County Emergency Medical Services ; Seattle ; WA ; USA
  9. Department of Medicine ; Division of General Internal Medicine ; University of Washington School of Medicine ; Seattle ; WA ; USA
  10. Department of Critical Care Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh ; PA ; USA
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：18
• 期：5
• 全文大小：405 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Prompt treatment of severe sepsis in the Emergency Department reduces deaths, but the role of prehospital fluid resuscitation is unknown. We sought to determine the risk-adjusted association between prehospital fluid administration and hospital mortality among emergency medical services (EMS) patients admitted with severe sepsis. Methods We performed a prospective, observational study of patients hospitalized with severe sepsis on admission among 45,394 adult EMS encounters taken to 15 hospitals from 11/2009 to 12/2010 by a two-tier EMS system in King County, Washington. The region mandated recording of prehospital intravenous catheter and fluid administration in prehospital records, along with detailed demographic, incident, physiologic, and hospital adjustment variables. We determined the effect of prehospital intravenous catheter or fluid versus no catheter or fluid on all-cause mortality using multivariable logistic regression. Results Of all encounters, 1,350 met criteria for severe sepsis on admission, of whom 205 (15%) died by hospital discharge, 312 (23%) received prehospital intravenous fluid, 90 (7%) received a prehospital catheter alone and 948 (70%) did not receive catheter or fluid. EMS administered a median prehospital fluid volume of 500聽mL (interquartile range (IQR): 200, 1000聽mL). In adjusted models, the administration of any prehospital fluid was associated with reduced hospital mortality (Odds ratio =0.46; 95% Confidence interval: 0.23, 0.88; P =0.02) compared to no prehospital fluid. The odds of hospital mortality were also lower among severe sepsis patients treated with prehospital intravenous catheter alone (Odds ratio =0.3; 95% Confidence interval: 0.17 to 0.57; P Conclusions In a population-based study, the administration of prehospital fluid and placement of intravenous access were associated with decreased odds of hospital mortality compared with no prehospital catheter or fluid.