Use of IV Fluids by EMTs Reduced Morality in Septic Patients With Low Blood Pressure Interview with:
"intravenous" by thorney torkelson is licensed under CC BY-NC-ND 2.0 <a href=""> CC BY-NC-ND 2.0</a>Daniel J. Lane PhD
Institute of Health Policy, Management and Evaluation
Dalla Lana School of Public Health, University of Toronto
Rescu, Li Ka Shing Knowledge Institute, St Michael’s Hospital
Toronto, Ontario, Canada  What is the background for this study?  What are the main findings?

Response: Early resuscitation and early antibiotics have become the mainstay treatment for patients with sepsis. The time to initiation of these treatments is thought to be an important factor in patients surviving their disease; however, the independent benefits or harms of intravenous fluid resuscitation, in particular a more aggressive versus more conservative approach to this therapy, remains difficult to evaluate given the concurrent use of these therapies in hospital.

To gain a better understanding of this treatment independent of antibiotic use, we assessed intravenous fluid resuscitation by paramedics on the in-hospital mortality of patients with sepsis. By accounting for the interaction between initial systolic blood pressure and the treatment, we found that earlier resuscitation by paramedics was associated with decreased mortality in patients with low initial blood pressures but not associated with mortality for patients with normal or higher initial blood pressures. What should readers take away from your report?

Response: This study supports the use of early intravenous fluid resuscitation in patients with sepsis and low initial systolic blood pressure. What recommendations do you have for future research as a result of this work?

Response: We showed that there is an interaction between initial systolic blood pressure and intravenous fluid resuscitation treatment effect. Future studies should account for this interaction in their study design or analysis. While considering this important methodological implication, future studies may explore the association of the volume of intravenous fluid provided on mortality to explore the question of more aggressive versus more conservative resuscitation strategies. 

No Disclosures. 


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 Netw Open. 2018;1(8):e185845. doi:10.1001/jamanetworkopen.2018.5845


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