Baggrund og baggrundslitteratur

Baggrund

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]. Kun ganske få studier har undersøgt sepsis-patienter uden septisk shock – evidensen er således yderst sparsom. Viden om væskebehandling af sepsispatienter uden shock bliver efterspurgt internationalt [21, 22]; hvor meget væske får patienterne, og hvor meget skal de have? Hvor meget væske patienter får nu, ønsker vi at belyse med ovenstående studie. Studiet skal danne grundlag for en power-beregning til et randomiseret studie om, hvor meget væske patienter skal have. 

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 surveyCrit 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 arrivalCrit 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 alDisease progression in hemodynamically stable patients presenting to the emergency department with sepsisAcad 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 departmentAcad 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 infectionEur 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 LevelCrit 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 PatientsCrit 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 databaseIntensive 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 alSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016Crit 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 alSurviving Sepsis Campaign guidelines for management of severe sepsis and septic shockCrit 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 practiceAnaesthesiol 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 SepsisN 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 mortalityCrit 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 deathShock (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 SepsisOpen 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 therapyAnn 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 sepsisAm 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 SIRSIntensive 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 alUnintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of EndotoxemiaAmerican 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 reviewEmergency 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 alThe intensive care medicine research agenda on septic shockIntensive Care Med 2017, 43(9):1294-1305.