Evidence map›Paper›PMID 31446829›Full record

ArticleJournal of intensive care medicine2020

Equipoise in Appropriate Initial Volume Resuscitation for Patients in Septic Shock With Heart Failure: Results of a Multicenter Clinician Survey.

Gabriel Wardi, Ian Joel, Julian Villar, Michael Lava, Eric Gross, Vaishal Tolia, Raghu R Seethala, Robert L Owens, Rebecca E Sell, Sydney B Montesi and 7 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
1.0field-weighted citation impact, top 24% 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

9 citing papers in PubMed, 13 citations in OpenAlex.

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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

17 authors at 11 institutions in 1 country.

Gabriel WardiDepartment of Emergency Medicine, 8784University of California, San Diego, CA, USA.ORCID https://orcid.org/0000-0002-4845-0217
Ian JoelDivision of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA.
Julian VillarDepartment of Emergency Medicine, Kaiser Oakland, CA, USA.
Michael Lava194441Wellstar Medical Group Pulmonary Medicine, Marietta, GA, USA.
Eric GrossDepartment of Emergency Medicine, 8784University of California, Davis, CA, USA.
Vaishal ToliaDepartment of Emergency Medicine, 8784University of California, San Diego, CA, USA.
Raghu R SeethalaDepartment of Emergency Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Robert L OwensDivision of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA.
Rebecca E SellDivision of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA.
Sydney B MontesiDivision of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Farbod N RahaghiDivision of Pulmonary and Critical Care Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Somnath BoseDepartment of Anesthesia, Critical Care, and Pain Medicine, 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.ORCID https://orcid.org/0000-0001-7310-9881
Ashish RaiDepartment of Pulmonary, Critical Care, and Sleep Medicine, 25218North Shore Medical Center, MA, USA.
Elizabeth K StevensonDepartment of Pulmonary, Critical Care, and Sleep Medicine, 25218North Shore Medical Center, MA, USA.
Jakob McSparronDivision of Pulmonary and Critical Care Medicine, 1259University of Michigan, Ann Arbor, MI, USA.
Vaishal ToliaDepartment of Emergency Medicine, 8784University of California, San Diego, CA, USA.
Jeremy R BeitlerCenter for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, 5798Columbia University, New York, NY.
University of California System · USBrigham and Women's Hospital · USNorth Shore Medical Center · USUniversity of California San Diego · USBeth Israel Deaconess Medical Center · USColumbia University · USHarvard University · USKaiser Permanente Oakland Medical Center · USUniversity of California, Davis · USUniversity of Michigan · USWellStar Health System · US

Funding

Obstructive Sleep Apnea Endotypes and Impact on Phenotypes of People Living with HIVR01HL142114 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI GRANT, IGOR, OWENS, ROBERT LLEWELLYN · 2018 to 2021
$2.0M
Computed Tomographic Insights Into Pulmonary HypertensionK23HL136905 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI RAHAGHI, FARBOD NICHOLAS · 2017 to 2021
$1.1M
Breath stacking dyssynchrony in acute respiratory distress syndromeK23HL133489 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI BEITLER, JEREMY R. · 2017 to 2021
$871k
NHLBI NIH HHS K23 HL133489NHLBI NIH HHS K23 HL136905NHLBI NIH HHS L30 HL129438NHLBI NIH HHS R01 HL142114
6 · The paper itself

Abstract

purposeInternational clinical practice guidelines call for initial volume resuscitation of at least 30 mL/kg body weight for patients with sepsis-induced hypotension or shock. Although not considered in the guidelines, preexisting cardiac dysfunction may be an important factor clinicians weigh in deciding the quantity of volume resuscitation for patients with septic shock.

methodsWe conducted a multicenter survey of clinicians who routinely treat patients with sepsis to evaluate their beliefs, behaviors, knowledge, and perceived structural barriers regarding initial volume resuscitation for patients with sepsis and concomitant heart failure with reduced ejection fraction (HFrEF) <40%. Initial volume resuscitation preferences were captured as ordinal values, and additional testing for volume resuscitation preferences was performed using McNemar and Wilcoxon signed rank tests as indicated. Univariable logistic regression models were used to identify significant predictors of ≥30 mL/kg fluid administration.

resultsA total of 317 clinicians at 9 US hospitals completed the survey (response rate 47.3%). Most respondents were specialists in either internal medicine or emergency medicine. Substantial heterogeneity was found regarding sepsis resuscitation preferences for patients with concomitant HFrEF. The belief that patients with septic shock and HFrEF should be exempt from current sepsis bundle initiatives was shared by 39.4% of respondents. A minimum fluid challenge of ∼30 mL/kg or more was deemed appropriate in septic shock by only 56.4% of respondents for patients with concomitant HFrEF, compared to 89.1% of respondents for patients without HFrEF (

conclusionsClinical equipoise exists regarding initial volume resuscitation for patients with sepsis-induced hypotension or shock and concomitant HFrEF. Future studies and clinical practice guidelines should explicitly address resuscitation in this subpopulation.

Indexed as

Heart FailureSepsisShock, SepticFluid TherapyHumansResuscitationStroke VolumeSurveys and QuestionnairesTherapeutic Equipoisecrystalloidfluid challengeresuscitationseptic shocksystolic heart failure

Identifiers

PMID31446829
PMCPMC7039763
OpenAlexW2971051404

What OpenQuestion holds

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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.