Evidence map›Paper›PMID 27388345›Full record

ArticleBMJ open2016

Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock.

Lauralyn McIntyre, Brian H Rowe, Timothy S Walsh, Alasdair Gray, Yaseen Arabi, Anders Perner, Anthony Gordon, John Marshall, Deborah Cook, Alison Fox-Robichaud and 10 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 19 citations in OpenAlex.

  1. Trial
  2. Article
  3. Review
  4. Article
  5. Advances in Sepsis Care.Clinics in chest medicine · 2022
    Review
  6. Article
  7. Article
  8. Fluid Management in Sepsis.Journal of intensive care medicine · 2019
    Review
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 14 institutions in 4 countries.

Lauralyn McIntyreDepartment of Medicine (Division of Critical Care), University of Ottawa, Ottawa, Ontario, Canada The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Brian H RoweDepartment of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Timothy S WalshDepartment of Anaesthetics, Critical Care, and Pain Medicine, University of Edinburgh, Edinburgh, UK.
Alasdair GrayDepartment of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
Yaseen ArabiKing Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Anders PernerDepartment of Intensive Care, Ringshospitalet, Copenhagen, Denmark.
Anthony GordonDepartment of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, London, UK.
John MarshallDepartment of Surgery, University of Toronto, Toronto, Ontario, Canada.
Deborah CookDepartments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Alison Fox-RobichaudDepartment of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
Sean M BagshawFaculty of Medicine and Dentistry, Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Robert GreenDepartment of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Irwin SchweitzerThe Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Alexis TurgeonDivision of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada Population Health and Optimal Health Practice Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec Research Center, CHU de Québec (Hôpital de l'Enfant-Jésus), Laval, Québec City, Québec, Canada.
Ryan ZarychanskiCancerCare Manitoba, Winnipeg, Manitoba, Canada.
Shane EnglishDepartment of Medicine (Division of Critical Care), University of Ottawa, Ottawa, Ontario, Canada The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Michaël ChasséThe Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ian StiellThe Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Dean FergussonThe Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Canadian Critical Care Trials Group
University of Ottawa · CAUniversity of Alberta · CACancerCare Manitoba · CADalhousie University · CAEdinburgh Royal Infirmary · GBHôpital de l'Enfant-Jésus · CAImperial College London · GBKing Saud bin Abdulaziz University for Health Sciences · SAMcMaster University · CAOttawa Hospital · CARigshospitalet · DKThrombosis and Atherosclerosis Research Institute · CAUniversity of Edinburgh · GBUniversity of Toronto · CA

Funding

CIHRDepartment of Health NIHR/CS/009/007
6 · The paper itself

Abstract

objectivesEvidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid administered in early septic shock to inform the design of future septic shock fluid resuscitation trials.

methodsUsing a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey.

resultsA total of 1097 physicians' responses were included. 1 L was the most frequent quantity of resuscitation fluid physicians indicated they would administer at a time (46.9%, n=499). Most (63.0%, n=671) stated that they would administer the fluid challenges as quickly as possible. Overall, normal saline and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said that they would use saline 'often' or 'always' in 27.9% (n=150) of instances. Only 1.0% (n=10) of respondents indicated that they would use hydroxyethyl starch 'often' or 'always'; use of 5% (5.6% (n=59)) or 20-25% albumin (1.3% (n=14)) was also infrequent. The majority (88.4%, n=896) of respondents indicated that a large randomised controlled trial comparing 5% albumin to a crystalloid fluid in early septic shock was important to conduct.

conclusionsCritical care and emergency physicians stated that they rapidly infuse volumes of 500-1000 mL of resuscitation fluid in early septic shock. Colloid use, specifically the use of albumin, was infrequently reported. Our survey identifies the need to conduct a trial on the efficacy of albumin and crystalloids on 90-day mortality in patients with early septic shock.

Indexed as

Critical CareEmergency MedicineAlbuminsCanadaColloidsCrystalloid SolutionsFluid TherapyHumansHydroxyethyl Starch DerivativesIsotonic SolutionsPlasma SubstitutesPractice Patterns, Physicians'ResuscitationRinger's SolutionSaudi ArabiaScandinavian and Nordic CountriesAlbuminsColloidsCrystalloid SolutionsHydroxyethyl Starch DerivativesIsotonic SolutionsPlasma SubstitutesRinger's SolutionSodium ChlorideAdultsCritical CareEmergency MedicineFluid resuscitationSeptic shockSurvey

Identifiers

PMID27388345
PMCPMC4947761
OpenAlexW2467536696

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.