Patients with sepsis who are transported to the emergency department (ED) via ambulance who receive early administration of intravenous (IV) fluids by paramedics have lower mortality, but only if they have a low initial systolic blood pressure (eg, <100 mm Hg), according to study findings published in JAMA Network Open. There was no association between mortality and early fluid administration in patients with higher initial systolic blood pressures.
Early identification and initiation of treatment for sepsis are associated with reduced mortality rate in patients and early IV fluid resuscitation is recommended, but the optimal strategy for fluid administration remains controversial. In this study, researchers evaluated the association between initial blood pressure and the early administration of IV fluids in patients with sepsis transported to the hospital by emergency services and in-hospital mortality.
The cohort included 1871 patients with sepsis who were transported to the ED during a 1-year period. Of these patients, 54.2% received IV fluids administered by paramedics, while 7.6% received a saline lock, but no IV fluids, and 38.2% did not receive any IV fluids. The overall in-hospital mortality was 28.2% (n=528). The researchers found a significant association between IV fluids and mortality, but demonstrated that it was dependent on the patient’s initial systolic blood pressure (range, 42-222 mm Hg; P <.001 for interaction).
At the median systolic blood pressure for the cohort (125 mm Hg), receipt of IV fluids was not associated with mortality (odds ratio 1.4; 95% CI, 0.8-2.4) but decreased mortality was observed in patients with low initial systolic blood pressure (eg, <100 mm Hg) who received IV fluids.
“Among patients with suspected sepsis, clinicians may consider administering intravenous fluids when the initial systolic blood pressure is low and a more restrictive approach to fluid resuscitation when systolic blood pressure is high,” wrote the researchers.
Lane DJ, Wunsch H, Saskin R, et al. Association between early intravenous fluids provided by paramedics and subsequent in-hospital mortality among patients with sepsis. JAMA Network Open. 2018;1(8):e185845.