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Title: An observational study of intensivists' expectations and effects of fluid boluses in critically ill patients.
Austin Authors: Wall, Olof;Cutuli, Salvatore L ;Wilson, Anthony;Eastwood, Glenn M ;Lipka-Falck, Adam;Törnberg, Daniel;Bellomo, Rinaldo ;Cronhjort, Maria
Affiliation: Intensive Care..
Adult Critical Care, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom..
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden..
Department of Anaesthesiology and Intensive Care, Danderyds Sjukhus, Stockholm, Sweden..
Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden..
Dipartimento di Scienze dell' Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy..
Issue Date: 24-Mar-2022
Date: 2022
Publication information: PloS one 2022; 17(3): e0265770
Abstract: Fluid bolus therapy (FBT) is common in ICUs but whether it achieves the effects expected by intensivists remains uncertain. We aimed to describe intensivists' expectations and compare them to the actual physiological effects. We evaluated 77 patients in two ICUs (Sweden and Australia). We included patients prescribed a FBT ≥250 ml over ≤30 minutes. The intensivist completed a questionnaire on triggers for and expected responses to FBT. We compared expected with actual values at FBT completion and after one hour. Median bolus size (IQR) was 300 ml (250-500) given over a median (IQR) of 21 minutes (15-30 mins). Boluses were 57% Ringer´s Acetate and 43% albumin (40-50g/L). Hypotension was the most common trigger (47%), followed by oliguria (21%). During FBT, 55% of patients received noradrenaline and 38% propofol. Intensivists expected a median MAP increase of 2.6 mmHg (IQR: -3.1 to +6.8) at end of bolus and of 1.3 mmHg (-3.5 to + 4.1) after one hour. Intensivist´s' expectations were judged to be accurate if they were within 5% above or below measured values. At FBT completion, 33% of MAP expectations were overestimations and 42% were underestimations. One hour later, 19% were overestimations and 43% were underestimations. Only 8% of expectations of measured urine output (UO) were accurate and 44% were overestimations. Correction for sedation or vasopressors did not modify these findings. The physiological expectations of intensivists after FBT carried a high risk of both over and underestimation. Since the physiological effect FBT was often small and did not meet clinical expectations, a reassessment of its rationale, effect, duration, and role appears justified.
DOI: 10.1371/journal.pone.0265770
ORCID: 0000-0001-7472-5168
Journal: PloS one
PubMed URL: 35324970
PubMed URL:
Type: Journal Article
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