Abstract
Fluid bolus therapy (FBT) is a standard of care in the management of the septic, hypotensive, tachycardic and/or oliguric patient. However, contemporary evidence for FBT improving patient-centred outcomes is scant. Moreover, its physiological effects in contemporary ICU environments and populations are poorly understood. Using three electronic databases, we identified all studies describing FBT between January 2010 and December 2013. We found 33 studies describing 41 boluses. No randomised controlled trials compared FBT with alternative interventions, such as vasopressors. The median fluid bolus was 500 ml (range 100 to 1,000 ml) administered over 30 minutes (range 10 to 60 minutes) and the most commonly administered fluid was 0.9% sodium chloride solution. In 19 studies, a predetermined physiological trigger initiated FBT. Although 17 studies describe the temporal course of physiological changes after FBT in 31 patient groups, only three studies describe the physiological changes at 60 minutes, and only one study beyond this point. No studies related the physiological changes after FBT with clinically relevant outcomes. There is a clear need for at least obtaining randomised controlled evidence for the physiological effects of FBT in patients with severe sepsis and septic shock beyond the period immediately after its administration.‘Just as water retains no shape, so in warfare there are no constant conditions’Sun Tzu (‘The Art of War’)Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0696-5) contains supplementary material, which is available to authorized users.
Highlights
All critically ill patients receive intravenous (IV) fluids, which are given to maintain physiological homeostasis, or as a vehicle for drug administration, or as direct therapeutic administration to correct perceived haemodynamic instability [1,2,3,4]
We identified 22 prospective observational studies, four retrospective observational studies, two quasi-experimental studies, and five randomised controlled trials (RCTs)
We examined the contemporary literature on Fluid bolus therapy (FBT) in severe sepsis and septic shock and identified 33 original studies describing the characteristics of a fluid bolus, 17 of which describe the associated physiological
Summary
All critically ill patients receive intravenous (IV) fluids, which are given to maintain physiological homeostasis, or as a vehicle for drug administration, or as direct therapeutic administration to correct perceived haemodynamic instability [1,2,3,4]. In these situations, where there is a perceived reduction in venous return and cardiac output secondary to vasodilatation and/or hypovolaemia, using IV fluid to increase intravascular volume is believed to effectively compensate for these changes in vascular tone by increasing stroke volume in accordance with the Frank-Starling principle [5,6,7,8,9,10]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
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