evaluation of fluid infusion with lifeflow for patients with suspected septic shock

Conditions: Sepsis; Volume Assessment

Summary: the lifeflow rapid infusion device is a handheld manually-operated device that has been shown in early trials to increase the rate of bolus fluid infusion up to 3 times the rate of delivery attributed to conventional rapid infusion devices. the device addresses other technical barriers to fluid resuscitation, including reducing complexity and provider fatigue. lifeflow utilizes standard iv or intraosseous (io) vascular access devices to quickly and efficiently deliver appropriate volumes of crystalloid fluid to patients during emergent fluid resuscitation. the purpose of this study is to determine if intravenous fluids can be administered more rapidly and efficiently with the use of the lifeflow rapid infusion device compared to the current standard techniques in adult patients who present to the emergency department with septic shock.

patients with conditions such as septic shock, anaphylaxis, and hypovolemic shock may require rapid fluid administration to restore blood pressure and tissue perfusion. newly updated surviving sepsis campaign (ssc) guidelines call for patients with septic shock to receive a 30ml/kg intravenous (iv) fluid challenge within 1 hour of emergency department (ed) arrival, with improved outcomes shown with early fluid infusion. patients with shock and severe hypotension may require even more rapid fluid treatment, up to 4ml/kg/min. while excess fluid infusion may be associated with harm, early fluid infusion for the reversal of shock can reduce the need for subsequent interventions, ultimately leading to improved patient outcomes. this may be especially true in patients with hypotension, who are at greater risk of death if not treated quickly, as a single episode of hypotension in patients with sepsis is correlated with a significantly increased risk of death. in patients who require iv fluid bolus therapy, technical barriers such as slow infusion rates, technically complex infusion devices, and inadequate nursing resources may lead to delay in fluid administration and inadequate resuscitation. as recommended by the ssc guidelines, patients receiving fluid bolus therapy for septic shock require frequent reassessment of clinical response. with current fluid delivery techniques, the ability to reassess quickly and relate fluid administration directly to markers of hemodynamic improvement is limited. the lifeflow rapid infusion device is a handheld manually-operated device that has been shown in early trials to increase the rate of bolus fluid infusion up to 3 times the rate of delivery attributed to conventional rapid infusion devices. the device addresses other technical barriers to fluid resuscitation, including reducing complexity and provider fatigue. lifeflow utilizes standard iv or intraosseous (io) vascular access devices to quickly and efficiently deliver appropriate volumes of crystalloid fluid to patients during emergent fluid resuscitation. the purpose of this study is to determine if intravenous fluids can be administered more rapidly and efficiently with the use of the lifeflow rapid infusion device compared to the current standard techniques in adult patients who present to the emergency department with septic shock. primary hypothesis * intravenous fluids can be administered more rapidly and efficiently with the use of the lifeflow rapid infusion device compared to the current techniques in patients who present to the ed with hypotension and suspected septic shock secondary hypotheses * hypotensive patients receiving intravenous fluids utilizing the lifeflow infusion device will have more rapid normalization of vital sign parameters (i.e., resolution of hypotension = map 65 mmhg or greater), and more rapid improvement in markers of tissue ischemia (i.e., lactate clearance) than patients receiving fluid using other techniques. * based on reduced icu and hospital length of stay (los), the overall cost of treatment will be lower in ed patients receiving early iv fluid resuscitation with lifeflow comparted to similar patients treated with standard techniques.

Eligibility criteria:
inclusion criteria: * adult ed patients ≥ 18 years of age * patients with hypotension (systolic blood pressure (sbp) \< 90) mmhg or mean arterial pressure (map) \< 65 mmhg) and at least one of the following: * temperature \> 101 f (38.3 c) or \< 96.8 f (36.0 c) * respiratory rate (rr) \> 22 bpm * heart rate (hr) \> 90/min * patients who will be determined by treating emergency physician to receive rapid fluid bolus for hypotension * patients with adequate cardiac windows * ef is 35% or greater * no increased number of b lines per rib interspace (3 or more) in multiple locations on lung ultrasound exclusion criteria: * heart failure by history or ejection fraction (ef) \< 35 percent on pre-enrollment point of care (poc) echocardiogram * history of end stage renal disease * history of end stage lung disease * lymphocyte count \< 50mm/m3 or absolute neutrophil count \< 500 * transferred from another facility * requirement for immediate surgery * patients with 14 gauge catheters or larger * concurrently on vasopressors or inotrope therapy * patients or legally acceptable representatives unable to provide consent * non-sepsis related primary diagnosis including: acute cerebral vascular event, acute coronary syndrome, acute pulmonary edema, status asthmaticus, major cardiac arrhythmia, active gastrointestinal hemorrhage, seizure, drug overdose, burn or trauma, myocardial infarction or active hemorrhage * incarcerated patients * requirement for immediate surgery * known pregnancy