Major sepsis study published in leading medical journal
Springboard Plus Grant recipient Dr Stephen Macdonald co-led the ARISE FLUIDS clinical trial, a major international study recently published in the New England Journal of Medicine. Professor Daniel Fatovich (Director of Research at East Metropolitan Health Service and Board Member of the RPH Research Foundation), and 2020 Doreen McCarthy Nursing Research Grant recipient Jonathon Burcham were co-authors.
The trial investigated whether patients presenting to emergency departments with early septic shock achieve better outcomes with a treatment approach using less intravenous fluid and earlier vasopressor therapy, compared with the traditional approach of larger fluid volumes and later vasopressor use.
Septic shock is a life-threatening complication of infection that requires urgent treatment to restore blood pressure and blood flow to vital organs. The optimal balance between fluid resuscitation and vasopressor therapy has remained an important clinical question.
The study enrolled 1,000 patients across 51 sites in Australia, New Zealand and Ireland. Patients were randomly assigned to receive either restricted fluids with earlier vasopressors or higher fluid volumes with later vasopressors.
The trial found no difference between the groups in the primary outcome of days alive and out of hospital at 90 days, with both groups recording a median of 76 days. Overall mortality and adverse event rates were also similar. However, pulmonary oedema (fluid build-up in the lungs) occurred less frequently in the early vasopressor group, but this group required more admissions to intensive care.
While the study did not identify one treatment strategy as superior, it provides important evidence to guide the early management of septic shock and highlights the value of large-scale clinical trials in informing patient care.
The RPH Research Foundation is proud to support researchers whose work is advancing medical knowledge, informing clinical practice, and improving care for patients locally and around the world.
