Shailesh Bihari1,2, David J Teubner3,4, Shivesh Prakash5, Thomas Beatty4, Mark Morphett4, Rinaldo Bellomo6,7,8, Andrew Bersten5,3. 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.
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.
Authors: Anja Lindén-Søndersø; Mårten Jungner; Martin Spångfors; Mohammed Jan; Adam Oscarson; Sally Choi; Thomas Kander; Johan Undén; Donald Griesdale; John Boyd; Peter Bentzer Journal: Ann Intensive Care Date: 2019-11-27 Impact factor: 6.925
Authors: Stephen P J Macdonald; David McD Taylor; Gerben Keijzers; Glenn Arendts; Daniel M Fatovich; Frances B Kinnear; Simon G A Brown; Rinaldo Bellomo; Sally Burrows; John F Fraser; Edward Litton; Juan Carlos Ascencio-Lane; Matthew Anstey; David McCutcheon; Lisa Smart; Ioana Vlad; James Winearls; Bradley Wibrow Journal: Trials Date: 2017-08-29 Impact factor: 2.279