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Emerg Med Australas. 2016 Oct;28(5):531-7. doi: 10.1111/1742-6723.12621. Epub 2016 Jul 3.

Fluid bolus therapy in emergency department patients: Indications and physiological changes.

Author information

1
Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. biharishailesh@gmail.com, biha0002@flinders.edu.au.
2
Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia. biharishailesh@gmail.com, biha0002@flinders.edu.au.
3
Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia.
4
Department of Emergency Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
5
Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
6
Department of Intensive Care, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.
7
The University of Melbourne, Melbourne, Victoria, Australia.
8
Monash University, Melbourne, Victoria, Australia.

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.

KEYWORDS:

blood pressure; emergency department; fluid bolus; fluid responder; respiratory rate; shock

PMID:
27374939
DOI:
10.1111/1742-6723.12621
[Indexed for MEDLINE]

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