Objectives: Evidence 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.
Methods: Using 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.
Results: A 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.
Conclusions: Critical 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.