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Title: Fluid bolus therapy in emergency department patients: Indications and physiological changes
Austin Authors: Bihari, Shailesh;Teubner, David J;Prakash, Shivesh;Beatty, Thomas;Morphett, Mark;Bellomo, Rinaldo ;Bersten, Andrew
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia
Department of Emergency Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
Department of Intensive Care, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Melbourne, Victoria, Australia
Monash University, Melbourne, Victoria, Australia
Issue Date: 3-Jul-2016
Date: 2016-07-03
Publication information: Emergency Medicine Australasia : EMA 2016; online first: 3 July
Abstract: OBJECTIVE: The aim of the present paper is to study the indications for fluid bolus therapy (FBT) and its associated physiological changes in ED patients. METHODS: Prospective observational study of FBT in a tertiary ED, we recorded indications, number, types and volumes, resuscitation goals and perceived success rates of FBT. Moreover, we studied key physiological variables before, 10 min, 1 h and 2 h after FBT. RESULTS: We studied 500 FBT episodes (750 [500-1250] mL). Median age was 59 (36-76) years and 57% were male. Shock was deemed present in 135 (27%) patients, septic shock in 80 (16%), and cardiogenic shock in 30 (6%). Overall, 0.9% saline (84%) was the most common fluid and hypotension the most common indication (70%). 'Avoidance of hospital/ICU admission' was the goal perceived to have the greatest success rate (85%). However, although mean arterial pressure (MAP) increased (P < 0.01) and heart rate (HR) decreased (P = 0.04) at 10 min (P = 0.01), both returned to baseline at 1 and 2 h. In contrast, respiratory rate (RR) increased at 1 (P < 0.01) and 2 h (P = 0.03) and temperature decreased at 1 and 2 h (both P < 0.001). In patients with shock, 1 h after FBT, there was a median 3 mmHg increase in MAP (P = 0.01) but no change in HR (P = 0.44), while RR increased (P < 0.01) and temperature decreased (P = 0.01). CONCLUSIONS: In ED, FBT is used mostly in patients without shock. However, after an immediate haemodynamic effect, FBT is associated with absent or limited physiological changes at 1 or 2 h. Even in shocked patients, the changes in MAP at 1 or 2 h after FBT are small.
Description: This study was presented at the American Thoracic Meeting, May 2015, Denver, USA.
DOI: 10.1111/1742-6723.12621
Journal: Emergency Medicine Australasia : EMA
PubMed URL:
Type: Journal Article
Subjects: Blood pressure
Emergency department
Fluid bolus
Fluid responder
Respiratory rate
Appears in Collections:Journal articles

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