Cardiac Output Monitoring Managing Intravenous Therapy (COMMIT) to Treat Emergency Department Patients with Sepsis

Peter C. Hou, Michael R. Filbin, Anthony Napoli, Joseph Feldman, Peter Pang, Jeffrey Sankoff, Bruce M. Lo, Howard Dickey-White, Robert H. Birkhahn, Nathan I. Shapiro

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

OBJECTIVES:: Fluid responsiveness is proposed as a physiology-based method to titrate fluid therapy based on preload dependence. The objectives of this study were to determine if: 1) a fluid responsiveness protocol would decrease progression of organ dysfunction; and, 2) a fluid responsiveness protocol would facilitate a more aggressive resuscitation. METHODS:: Prospective, 10-center, randomized interventional trial. Inclusion criteria: a) suspected sepsis and lactate 2.0–4.0?mmol/l. Exclusion criteria (abbreviated): a) SBP10% increase in stroke volume in response to 5?cc/kg fluid bolus) with balance of a liter given in responsive patients.. Control: standard clinical care. Outcomes: primary - change in SOFA >=1 over 72?hours; secondary - fluids administered. Trial was initially powered at 600 patients, but stopped early due to a change in sponsorʼs funding priorities. RESULTS:: Sixty-four patients were enrolled with 32 in the treatment arm. There were no significant differences between arms in age, co-morbidities, baseline vital signs or SOFA scores (p?>?0.05 for all). Comparing treatment vs SOC - there was no difference in increase in SOFA >= 1 (30% vs 33%) [n.b. underpowered, p?=?1.0] or pre-protocol fluids 1050cc (95%CI 786–1314) vs 1031 cc (741–1325) (p?=?0.93); however, treatment patients received more fluids during the protocol [2633cc (2264–3001) vs 1002cc (707–1298)] (p?

Original languageEnglish (US)
JournalShock
DOIs
StateAccepted/In press - Jan 12 2016

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ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Hou, P. C., Filbin, M. R., Napoli, A., Feldman, J., Pang, P., Sankoff, J., Lo, B. M., Dickey-White, H., Birkhahn, R. H., & Shapiro, N. I. (Accepted/In press). Cardiac Output Monitoring Managing Intravenous Therapy (COMMIT) to Treat Emergency Department Patients with Sepsis. Shock. https://doi.org/10.1097/SHK.0000000000000564