Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial

Authors: Matthew J. Maiden, Mark E. Finnis, Sandra Peake, Simon McRae, Anthony Delaney, Michael Bailey, Rinaldo Bellomo

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

Background

Intravenous fluids may contribute to lower haemoglobin levels in patients with septic shock. We sought to determine the relationship between the changes in haemoglobin concentration and the volume of intravenous fluids administered during resuscitation from septic shock.

Methods

We performed a retrospective cohort study of patients enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial who were not transfused red blood cells (N = 1275). We determined the relationship between haemoglobin concentration, its change over time and volume of intravenous fluids administered over 6, 24 and 72 h using univariate and multivariate analysis.

Results

Median (IQR) haemoglobin concentration at baseline was 133 (118–146) g/L and decreased to 115 (102–127) g/L within the first 6 h of resuscitation (P < 0.001), 110 (99–122) g/L after 24 h, and 109 (97–121) g/L after 72 h. At the corresponding time points, the cumulative volume of intravenous fluid administered was 1.3 (0.7–2.2) L, 2.9 (1.8–4.3) L and 4.6 (2.7–7.1) L. Haemoglobin concentration and its change from baseline had an independent but weak association with intravenous fluid volume at each time point (R2 < 20%, P < 0.001). After adjusting for covariates, each litre of intravenous fluid administered was associated with a change in haemoglobin concentration of − 1.0 g/L (95% CI −1.5 to −0.6, P < 0.001) at 24 h and − 1.3 g/L (− 1.6 to − 0.9, P < 0.001) at 72 h.

Conclusions

Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered.
Appendix
Available only for authorised users
Literature
1.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77.CrossRefPubMed
2.
3.
4.
Abraham E, Singer M. Mechanisms of sepsis-induced organ dysfunction. Crit Care Med. 2007;35:2408–16.CrossRefPubMed
5.
6.
7.
Enkhbaatar P, Joncam C, Traber L, Nakano Y, Wang J, Lange M, et al. Novel ovine model of methicillin-resistant Staphylococcus aureus-induced pneumonia and sepsis. Shock. 2008;29:642–9.PubMed
8.
Maiden MJ, Chapman MJ, Torpy DJ, Kuchel TR, Clarke IJ, Nash CH, et al. Triiodothyronine administration in a model of septic shock: a randomized blinded placebo-controlled trial. Crit Care Med. 2016;44:1153–60.CrossRefPubMed
9.
Kubiak BD, Albert SP, Gatto LA, Vieau CJ, Roy SK, Snyder KP, et al. A clinically applicable porcine model of septic and ischemia/reperfusion-induced shock and multiple organ injury. J Surg Res. 2011;166:e59–69.CrossRefPubMed
10.
Hinshaw LB, Taylor FB Jr, Chang AC, Pryor RW, Lee PA, Straughn F, et al. Staphylococcus aureus-induced shock: a pathophysiologic study. Circ Shock. 1988;26:257–65.PubMed
11.
12.
de Carvalho H, Matos JA, Bouskela E, Svensjo E. Vascular permeability increase and plasma volume loss induced by endotoxin was attenuated by hypertonic saline with or without dextran. Shock. 1999;12:75–80.CrossRefPubMed
13.
Maybauer DM, Maybauer MO, Szabo C, Westphal M, Traber LD, Salzman AL, et al. The peroxynitrite catalyst WW-85 improves microcirculation in ovine smoke inhalation injury and septic shock. Burns. 2011;37:842–50.CrossRefPubMed
14.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400–15. 16.CrossRefPubMed
15.
16.
Working Group IAP/APA acute pancreatitis guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1–15.CrossRef
17.
18.
Jansma G, de Lange F, Kingma WP, Vellinga NA, Koopmans M, Kuiper MA, et al. ‘Sepsis-related anemia’ is absent at hospital presentation; a retrospective cohort analysis. BMC Anesthesiol. 2015;15:55.CrossRefPubMedPubMedCentral
19.
Nguyen BV, Bota DP, Melot C, Vincent JL. Time course of hemoglobin concentrations in nonbleeding intensive care unit patients. Crit Care Med. 2003;31:406–10.CrossRefPubMed
20.
Delaney AP, Peake SL, Bellomo R, Cameron P, Holdgate A, Howe B, et al. The Australasian Resuscitation in Sepsis Evaluation (ARISE) trial statistical analysis plan. Crit Care Resusc. 2013;15:162–71.PubMed
21.
Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–506.CrossRefPubMed
22.
Kanhere MH, Bersten AD. Increased blood volume following resolution of acute cardiogenic pulmonary oedema: a retrospective analysis. Crit Care Resusc. 2011;13:108–12.PubMed
23.
Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288:1499–507.CrossRefPubMed
24.
Hayden SJ, Albert TJ, Watkins TR, Swenson ER. Anemia in critical illness: insights into etiology, consequences, and management. Am J Respir Crit Care Med. 2012;185:1049–57.CrossRefPubMedPubMedCentral
25.
Kempe DS, Akel A, Lang PA, Hermle T, Biswas R, Muresanu J, et al. Suicidal erythrocyte death in sepsis. J Mol Med. 2007;85:273–81.CrossRefPubMed
26.
Fonseca RB, Mohr AM, Wang L, Sifri ZC, Rameshwar P, Livingston DH. The impact of a hypercatecholamine state on erythropoiesis following severe injury and the role of IL-6. J Trauma. 2005;59:884–9.CrossRefPubMed
27.
28.
Nieuwdorp M, van Haeften TW, Gouverneur MC, Mooij HL, van Lieshout MH, Levi M, et al. Loss of endothelial glycocalyx during acute hyperglycemia coincides with endothelial dysfunction and coagulation activation in vivo. Diabetes. 2006;55:480–6.CrossRefPubMed
29.
Marx G, Cobas Meyer M, Schuerholz T, Vangerow B, Gratz KF, Hecker H, et al. Hydroxyethyl starch and modified fluid gelatin maintain plasma volume in a porcine model of septic shock with capillary leakage. Intensive Care Med. 2002;28:629–35.CrossRefPubMed
Metadata
Title
Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial
Authors
Matthew J. Maiden
Mark E. Finnis
Sandra Peake
Simon McRae
Anthony Delaney
Michael Bailey
Rinaldo Bellomo
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2029-6

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Letter

The choice of a postpyloric tube and the patient’s position in our procedure: A response

Letter

Optimizing micafungin dosing in critically ill patients: what about extracorporeal therapies?

Research

Detection of inspiratory recruitment of atelectasis by automated lung sound analysis as compared to four-dimensional computed tomography in a porcine lung injury model

Research

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

Review

Close down the lungs and keep them resting to minimize ventilator-induced lung injury

Review

Gut–kidney crosstalk in septic acute kidney injury