Understanding How Clinicians Personalize Fluid and Vasopressor Decisions in Early Sepsis Management
Authors' conclusion
These findings suggest that fluid volume received is the predominant factor associated with ongoing fluid and vasopressor decisions, outweighing many other clinical factors. Peripheral vasopressor use is common.
Study context
- Population
- US clinicians in the SCCM membership roster responding to vignettes of patients with sepsis11,203 invited
- Participants
- 550 clinicians
- Exposure
- Clinical factors in randomized sepsis vignettes (eg, fluid received, volume status) and resuscitation decisions
- Outcome
- Associations of clinical factors with decisions about fluid administration, vasopressor initiation and vasopressor route (adjusted proportions)
Methodological detailsclinical vignette survey, randomized vignette clinical factors, multivariable logistic regression, Conducted November 2022 to January 2023
- Clinical vignette survey
- Randomized vignette clinical factors
- Multivariable logistic regression
- Conducted November 2022 to January 2023
Main finding
As reported in the abstract
Fluid and vasopressor decisions by fluid volume already received
| Group | Value | Initiated vasopressors (adjusted) |
|---|---|---|
| After 1 L | adjusted proportion 82.5% (95% CI 80.2%–84.8%) | 55.0% (95% CI, 51.9%-58.1%) |
| After 5 L | adjusted proportion 17.5% (95% CI 15.1%–19.9%) | 92.7% (95% CI, 91.1%-94.3%) |
Value
After 1 Ladjusted proportion 82.5% (95% CI 80.2%–84.8%)
After 5 Ladjusted proportion 17.5% (95% CI 15.1%–19.9%)
Initiated vasopressors (adjusted)
After 1 L55.0% (95% CI, 51.9%-58.1%)
After 5 L92.7% (95% CI, 91.1%-94.3%)
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Fluid prescribed by examined volume status | Dry adjusted proportion 66.9% (95% CI 62.5%–71.2%) · Wet (overloaded) adjusted proportion 26.5% (95% CI 22.3%–30.6%) |
| Central line placement on peripheral norepinephrine, by dose | 0.5 µg/kg/min adjusted proportion 78.0% (95% CI 74.7%–81.2%) · 0.08 µg/kg/min adjusted proportion 25.2% (95% CI 21.8%–28.5%) |
| Central line placement on peripheral norepinephrine, by duration | 24 hours adjusted proportion 59.5% (95% CI 56.6%–62.5%) · 8 hours adjusted proportion 47.1% (95% CI 44.0%–50.1%) |
Other clinical factors (medical history, respiratory status, lactate trend, AKI)
- Small associations with fluid and vasopressor decisions
Willing to start vasopressors via peripheral IV catheter without central access
- Vignettes (of 1127)
- 1023 (90.8%)
Original publication
Understanding How Clinicians Personalize Fluid and Vasopressor Decisions in Early Sepsis Management. JAMA Netw Open. Published 1 April 2024. doi:10.
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