Introduction
Methods
Study inclusion criteria
Population of included studies
Intervention - fluid bolus administration
Comparator - alternatives to fluid administration
Between groups analysis
Outcome - physiological effects of bolus administration
Data collection
Statistical analysis
Results
Electronic search
Relevant contemporary studies
First author | Journal | Year | Aims of study | Location | Institution(s) | Study type | Population size |
---|---|---|---|---|---|---|---|
Bihari [36] |
Shock
| 2013 | Investigation of the use and effects of fluid boluses in septic patients following primary resuscitation | Australia | Single centre, academic ICU | Prospective observational study | 50 patients with severe sepsis or septic shock |
Castellanos-Ortega [37] |
Critical Care Medicine
| 2010 | Evaluation of the impact of a standardised EGDT response to sepsis | Spain | Single centre, academic ICU | Quasi-experimental study | 480 patients with septic shock |
De Backer [38] |
New England Journal of Medicine
| 2010 | Assessing the effect of noradrenaline as first-line vasopressor on mortality | Europe | 8 centres, mixed ICUs | Randomised clinical trial | 1,679 patients with shock requiring vaspressor therapy. 1,044 patients with sepsis |
Dong [39] |
World Journal of Emergency Medicine
| 2012 | Investigating the relationship between stroke volume index and passive leg raising and fluid responsiveness | China | 2 centres, general ICUs | Prospective observational study | 32 mechanically ventilated patients with septic shock |
Freitas [40] |
British Journal of Anaesthesia
| 2013 | Evaluation of the predictive value of automated PPV for fluid responsiveness in patients with sepsis and low tidal volumes | Brazil | Single centre, academic ICU | Prospective observational study | 40 patients with low tidal volume ventilation and severe sepsis or septic shock requiring a fluid challenge |
Gaieski [41] |
Critical Care Medicine
| 2010 | Evaluation of the impact of a standardised EGDT response to sepsis on time to antibiotic administration and survival | USA | Single centre, academic ICU | Retrospective observational study | 261 patients with severe sepsis and septic shock undergoing EGDT |
Hamzaoui [42] |
Critical Care
| 2010 | Evaluation of the cardiac consequences of early administration of noradrenaline | France | Single centre, academic ICU | Prospective observational study | 105 patients with septic shock requiring vasopressor commencement following initial fluid resuscitation |
Hanzelka [43] |
Supportive Care in Cancer
| 2013 | Evaluation of the impact of a standardised EGDT response to sepsis | USA | Single centre, academic ED | Retrospective observational study | 200 patients with cancer and severe sepsis or septic shock presenting to ED |
Jacob [44] |
Critical Care Medicine
| 2012 | Evaluation of the impact of early monitored sepsis management | Uganda | 2 centres, medical/treatment centres | Prospective observational study | 671 patients with severe sepsis presenting within office hours |
Khwannimit [45] |
European Journal of Anaesthesiology
| 2012 | Comparing SVV by Vigileo with PPV by monitor to predict fluid responsiveness | Thailand | Single centre, academic ICU | Prospective observational study | 42 patients with septic shock who were mechanically ventilated with tidal volumes >8 ml/kg requiring fluid resuscitation |
Lakhal [46] |
Intensive Care Medicine
| 2013 | Identification of fluid responsiveness from IABP and NIBP | France | 3 centres, academic ICU | Prospective observational study | 130 patients with circulatory failure requiring a fluid challenge. 58 patients with septic shock |
Lanspa [47] |
Journal of Critical Care
| 2012 | Assessment of CVP and shock index to predict haemodynamic response to volume expansion when compared with CVP alone | USA | Single centre, academic ICU | Prospective observational study | 25 patients with septic shock over 14 years of age |
Machare-Delgado [48] |
Journal of Intensive Care Medicine
| 2011 | Predicting fluid responsiveness by comparing SVV and inferior vena caval respiratory variation by ECHO during mechanical ventilation | USA | Single centre, medical academic ICU | Prospective observational study | 25 mechanically ventilated vasopressor-dependent patients who required a fluid challenge. 22 patients with severe sepsis or septic shock |
MacRedmond [49] |
Quality and Safety in Health Care
| 2010 | Evaluation of the impact of implementing a quality initiative on the management of severe sepsis and septic shock | Canada | Single centre, ICU | Quasi-experimental study | 74 patients with severe sepsis or septic shock admitted via ED |
Mahjoub [50] |
Intensive Care Medicine
| 2012 | Assessment of the impact of volume expansion on patients with left ventricular dysfunction | France | Single centre, academic ICU | Prospective observational study | 83 mechanically ventilated patients with sepsis-induced circulatory failure |
McIntyre [51] |
Journal of Critical Care
| 2012 | Feasibility study comparing the effects of 5% albumin versus 0.9% saline for resuscitation in septic shock | Canada | 6 centres, academic ED and ICU | Randomised clinical trial | 50 patients with refractory hypotension and sepsis |
Monnet [52] |
Critical Care
| 2010 | Comparing haemodynamic changes induced by noradrenaline and volume expansion using Vigileo and PiCCO | France | Single centre, academic medical ICU | Prospective observational study | 80 patients with sepsis-induced circulatory failure |
Monnet [53] |
Critical Care Medicine
| 2011 | Assessing the effects of noradrenaline on haemodynamics in sepsis | France | Single centre, academic medical ICU | Prospective observational study | 25 patients with sepsis-induced fluid-responsive acute circulatory failure with DBP <40 mmHg, or requiring noradrenaline |
Monnet [54] |
Critical Care Medicine
| 2013 | Comparing ScvO2 and markers of anaerobic metabolism as predictors of unfavourable changes in oxygen extraction | France | Single centre, academic medical ICU | Prospective observational study | 51 patients with acute circulatory failure undergoing transpulmonary thermodilution monitoring, 40 patients with septic shock |
Monnet [55] |
Critical Care Medicine
| 2011 | Investigation of the utility of pulse pressure as a surrogate for changes in cardiac output | France | Single centre, academic medical ICU | Prospective observational study | 373 patients with acute circulatory failure requiring a fluid challenge or the introduction or dose increase of noradrenaline. 338 patients with septic shock |
O’Neill [56] |
Journal of Emergency Medicine
| 2012 | Evaluation of the most difficult elements of a SSC protocol to implement in a community-based ED | USA | Single centre, community ED | Retrospective observational study | 79 with severe sepsis or septic shock remaining hypotensive following 2,000 ml of fluid resuscitation |
Ospina-Tascon [57] |
Intensive Care Medicine
| 2010 | Evaluation of the effects of fluid administration on microcirculatory alterations in sepsis | Belgium | Single centre, academic ICU | Prospective observational study | 60 patients with severe sepsis requiring fluid challenge. 37 within 24 hours of diagnosis, 23 after 48 hours |
Patel [58] |
Annals of Pharmacotherapy
| 2010 | Investigation of the implementation and effects of introducing the SSC guidelines | USA | Single centre, community ICU | Prospective observational study | 112 patients with sepsis or septic shock |
Pierrakos [59] |
Intensive Care Medicine
| 2012 | Evaluation of the correlation between changes in MAP and CI following fluid challenge | Belgium | Single centre, academic ICU | Prospective observational study | 51 patients with septic shock undergoing invasive haemodynamic monitoring and requiring a fluid challenge |
Pottecher [60] |
Intensive Care Medicine
| 2010 | Assessment of sublingual microcirculatory changes in response to fluid challenge | France | 2 centres, academic ED | Prospective observational study | 25 mechanically ventilated patients with severe sepsis or septic shock within 24 hours of ICU admission demonstrating pre-load dependency |
Sanchez [61] |
Anaesthesia and Intensive Care
| 2011 | Measuring the response to a fluid load in patients with and without septic shock | Spain | Single centre, academic ICU | Prospective observational study | 32 patients requiring invasive monitoring. 18 patients with septic shock |
Schnell [62] |
Critical Care Medicine
| 2013 | Assessment of the effects of a fluid challenge on Doppler-based renal resistive index in critically ill patients | France | 3 centres, academic ICUs | Prospective observational study | 35 mechanically ventilated patients with real-time cardiac monitoring requiring a fluid challenge. 30 patients with sepsis |
Sturgess [63] |
Anaesthesia and Intensive Care
| 2010 | Comparison of aortic corrected flow time, BNP and CVP as predictors of fluid responsiveness | Australia | Single centre, private ICU | Prospective observational study | 10 patients with septic shock requiring a fluid challenge |
Trof [64] |
Critical Care Medicine
| 2012 | Comparison of volume-guided and pressure-guided hemodynamic management in shocked patients | Netherlands | 2 centres, academic, ICU | Randomised clinical trial | 120 patients with shock requiring invasive haemodynamic monitoring and >48 hours of ICU admission. 72 patients with sepsis |
van Haren [65] |
Shock
| 2012 | Evaluation of the effects of hypertonic versus isotonic fluid administration in patients with septic shock | Netherlands | Single centre, academic ICU | Randomised clinical trial | 24 patients with septic shock enrolled within 24 hours of admission |
Wacharasint [66] |
Journal of the Medical Association of Thailand
| 2012 | Evaluation of the effectiveness of three dynamic measures of fluid responsiveness in septic shock patients | Thailand | Single centre, medical ICU | Prospective observational study | 20 patients with sepsis and acute circulatory failure with invasive haemodynamic monitoring stable for 15 minutes prior to inclusion |
Yu [67] |
Shock
| 2011 | Evaluation of the effects of blood volume analysis compared with pulmonary artery catheter monitoring | North America | Single centre, academic ICU | Randomised clinical trial | 100 patients requiring resuscitation for shock. 69 patients with severe sepsis or septic shock |
Zhang [68] |
Journal of Critical Care
| 2012 | Investigation of the association between plasma protein levels and subsequent pulmonary oedema | China | Single centre, academic ICU | Retrospective observational study | 62 patients with sepsis undergoing transpulmonary thermodilution assessment requiring fluid |
Pre-fluid bolus therapy fluid administration
First author | Year | Initial resuscitation | Bolus fluid type | Bolus fluid volume (ml) | Bolus fluid rate (minutes) | Physiological trigger for fluid administration | Physiological end-point for fluid administration | Number of boluses administered | Vasoactive administration? | Packed red cell transfusion? |
---|---|---|---|---|---|---|---|---|---|---|
Bihari [36] | 2013 | Undefined | 4% albumin | 750 | <30 | Clinician defined | Clinician defined | 2 | Yes | Not described |
Packed red cells | ||||||||||
20% albumin | ||||||||||
Fresh frozen plasma | ||||||||||
4% gelatin | ||||||||||
0.9% saline | ||||||||||
Castellanos-Ortega [37] | 2010 | Undefined | Crystalloid | 1,000 | 30 | Hypotension | CVP ≥8 mmHg, MAP ≥65 mmHg, ScvO2 ≥ 70% | Not described | Yes | Not described |
Colloid | 500 | |||||||||
De Backer [38] | 2010 | 500 ml colloid or 1,000 ml crystalloid | Crystalloid | 1,000 | Not defined | MAP <70 mmHg; SBP <100 mmHg, altered mental state; mottled skin; oliguria >1 hour, hyperlactataemia | Not described | Not described | Yes | Not described |
Colloid | 500 | |||||||||
Dong [39] | 2012 | Undefined | 6% HES | 500 | 30 | SBP <90 mmHg or >40 mmHg drop or need for vasopressors, oliguria >1 hour; mottled skin; HR >100 bpm | End of infusion. | 1 | Not described | Not described |
Freitas [40] | 2012 | Undefined | 6% HES | 7 ml/kg (max 500) | 30 | Clinician defined | End of infusion | 1 | Yes | No |
Gaieski [41] | 2010 | 20-30 ml/kg | 0.9% saline | 500 | 15-20 | CVP <8 mmHg | CVP >8 mmHg | Not described | Yes | Yes |
Hamzaoui [42] | 2010 | Undefined | 0.9% saline | 1,000 | Not defined | Undefined | Not described | Not described | Yes | Not described |
Hanzelka [43] | 2013 | 20 ml/kg | Undefined | 1,000 | 60 | Severe sepsis | SBP >90 mmHg, MAP <65 mmHg | Not described | Yes | No |
500 | 30 | |||||||||
Jacob [44] | 2012 | Undefined | 0.9% saline | 1,000 | 60 | SBP <100 mmHg or hyperlactataemia | SBP increased by 10 mmHg for 2 consecutive hours to >90 mmHg | Up to 10 | No | Not described |
500 | 30 | |||||||||
Khwannimit [45] | 2012 | Undefined | 6% HES | 500 | 30 | Clinician defined | End of infusion | 1 | Yes | Not described |
Lakhal [46] | 2013 | Undefined | 4% gelatin | 500 | 30 | One or more of SBP <90 mmHg, MAP <65 mmHg , requiring vasoactive medication, oliguria, skin mottling, hyperlactataemia | End of infusion | 1 | Yes | Not described |
Lanspa [47] | 2012 | 5,060 ml | Crystalloid (or equivalent colloid) | 20 ml/kg | <20 | Clinician defined | End of infusion | 1.36 | Yes | Yes |
Machare-Delgado [48] | 2011 | Undefined | 0.9% saline | 500 | 10 | Clinician defined | End of infusion | 1 | Not described | No |
MacRedmond [49] | 2010 | 25 ml/kg | 0.9% saline | 500 | <15 | MAP <65 mmHg | CVP 8-12; MAP >65 mmHg; ScvO2 > 70% | Not described | Yes | Yes |
Mahjoub [50] | 2013 | Undefined | 0.9% saline | 500 | 20 | SBP <90 mmHg and/or need for vasoactive drugs and/or persistent lactic acidosis | End of infusion | 1 | Yes | Not described |
McIntyre [51] | 2012 | 2,400 ml | 0.9% saline or 4% albumin | 500 | STAT | Undefined | Not described | 6 | Yes | Not described |
Monnet [52] | 2010 | Undefined | 0.9% saline | 500 | 30 | SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria | End of infusion | 1 | Yes | Not described |
Monnet [53] | 2011 | 2,200 ml | 0.9% saline | 500 | 10 | SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria | End of infusion | 1 | Yes | Not described |
Monnet [54] | 2013 | Undefined | 0.9% saline | 500 | 30 | SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria | End of infusion | 1 | Yes | Yes |
Monnet [55] | 2011 | Undefined | 0.9% saline | 500 | 20 | SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria | End of infusion | 1 | Yes | Not described |
O’Neill [56] | 2012 | 20 ml/kg | 0.9% saline | 500 | 15 | CVP <8 mmHg; MAP <65 mmHg; ScvO2 < 70% | CVP 8-12; MAP >65 mmHg; ScvO2 > 70% | 0.68 | Yes | Not described |
Ospina-Tascon [57] | 2010 | Undefined | CSL | 1,000 | 30 | MAP <65 mmHg | End of infusion | 1 | Yes | Not described |
4% albumin | 400 | |||||||||
Patel [58] | 2010 | 2,000 ml | Normal saline | Undefined | 30 | SBP <90 mmHg; MAP <65 mmHg | Not described | 1 | Yes | Not described |
Pierrakos [59] | 2012 | Undefined | CSL | 100 | 30 | Clinician defined | End of infusion | 1 | Yes | Not described |
6% HES | 500 | |||||||||
Pottecher [60] | 2010 | Undefined | HES 6% or 0.9% saline | 500 | 30 | MAP <65 mmHg, skin mottling or oliguria | End of infusion | 1 | Yes | Not described |
Sanchez [61] | 2011 | Undefined | Crystalloid | 1,000 | Undefined | Hypotension with perfusion abnormalities | Not described | Yes | No | |
Colloid | 500 | ITBVI >900 ml/ml or EVLWI >10 ml/kg | ||||||||
Schnell [62] | 2013 | Undefined | 0.9% saline | 500 | 15-30 | Clinician defined | End of infusion | 1 | Yes | Not described |
Sturgess [63] | 2010 | Undefined | 4% albumin | 250 | 15 | Clinician defined | End of infusion | 1 | Yes | No |
Trof [64] | 2012 | Undefined | HES or 4% gelatin | 250-500 | 30 | EVLWI <10 ml/kg or >10 ml/kg with GEDVI <850 ml/m2; PAOP >18 mmHg; MAP <65 mmHg, HR >100, SvO2 < 65% or ScvO2 < 70%; oliguria; peripheral perfusion deficits, hyperlactatemia | MAP >65 mmHg, ScvO2 > 70%, lactate clearance, diuresis >0.5 ml/kg/hour, restoration of peripheral perfusion deficits | 3.48 | Yes | Not described |
van Haren [65] | 2012 | Undefined | 6% HES in 0.9% saline | 500 | 15 | Septic shock | End of infusion | 1 | Yes | Not described |
250 | 15 | |||||||||
6% HES in 7.2% saline | ||||||||||
Wacharasint [66] | 2013 | Undefined | HES 6% | 500 | 30 | SBP <90 mmHg or requirement for vasopressors | End of infusion | 1 | Yes | Not described |
Yu [67] | 2011 | 30 ml/kg in 1,000 ml increments | Crystalloid or colloid | 250-500 | Undefined | PAOP <12 mmHg or 12-17 mmHg with | SBP >100 mmHg, HR <100 bpm, UO >0.5 ml/kg/hour, lactate clearance, SmvO2 > 70% | Not described | Not described | Yes |
SBP <100; HR >100 bpm UO <0.5 ml/kg/hour; hyperlactataemia; SvO2 > 70% or equivalent blood volume goals | ||||||||||
Zhang [68] | 2012 | Undefined | Crystalloid or colloid | 250-500 | 30 | SBP <90 mmHg; HR >100 bpm; GEDVI <700 ml/m2; CVP <12 mmHg (PEEP dependent) | Pre-defined rise in CVP | Not described | Yes | Not described |
Initiation and cessation of fluid bolus therapy
Defining fluid bolus therapy
Haemodynamic changes after fluid bolus therapy
Comparing different interventions
Temporal trends in physiological changes following fluid bolus therapy
First author | Fluid given | Group | Time from completion of fluid administration until physiological measurement (minutes) | Measure of central tendency | Change in cardiac output estimation | Change in heart rate (bpm) | Change in mean arterial pressure (mmHg)) | Change in central venous pressure (mmHg) | Change in venous oxygen saturation (%) | Change in blood lactate concentration (mmol/l) | Change in urine output | Change in haemoglobin concentration (g/L) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Haemodynamic indices measured immediately following fluid bolus administration
| ||||||||||||
Machare-Delgado [48] | 500 ml of 0.9% saline over 10 minutes | Responders: >10% SVI increase | 0 | Mean | +3.99 ml/m2/beat | |||||||
500 ml of 0.9% saline over 10 minutes | Non-responders: >10% SVI increase | 0 | Mean | +0.57 ml/m2/beat | ||||||||
Dong [39] | 500 ml of 6% HES over 30 minutes | Responders: >15% SVI increase | 0 | Mean | +600 ml/min/m2 | -1.5 | +15.2 | +3.2 | ||||
500 ml of 6% HES over 30 minutes | Non-responders: <15% SVI increase | 0 | Mean | +300 ml/min/m2 | -1.2 | +4.8 | +2.3 | |||||
Khwannimit [45] | 500 ml of 6% HES over 30 minutes | Responders: >15% SVI increase | 0 | Mean | +1300 ml/min/m2 | -3.3 | +9.5 | +3.4 | ||||
500 ml of 6% HES over 30 minutes | Non-responders: <15% SVI increase | 0 | Mean | +200 ml/min/m2 | -0.9 | +3.9 | +5.2 | |||||
Lakhal [46] | 500 ml of 4% gelatin over 30 minutes | Responders: >15% SVI increase | 0 | Mean | +900 ml/min/m2 | -6 | +14 | +3 | ||||
500 ml of 4% gelatin over 30 minutes | Non-responders: <15% SVI increase | 0 | Mean | +0 ml/min/m2 | -3 | +7 | +4.5 | |||||
Mahjoub [50] | 500 ml of 0.9% saline over 20 minutes | Responders: >10% SV increase | 0 | Mean | +1,000 ml/min | -4 | +7 | +2.6 | ||||
500 ml of 0.9% saline over 20 minutes | Non-responders: >10% SV increase | 0 | Mean | +300 ml/min | -3 | +1 | +2.9 | |||||
Monnet [53] | 500 ml of 0.9% saline over 10 minutes | All patients | 0 | Mean | +800 ml/min/m2 | -7 | +8 | +5 | ||||
Monnet [55] | 500 ml of 0.9% saline over 20 minutes | Responders: >15% CI increase | 0 | Mean | +800 ml/min/m2 | -2 | +11 | |||||
500 ml of 0.9% saline over 20 minutes | Non-responders: <15% increase in CI | 0 | Mean | +200 ml/min/m2 | -2 | +4 | ||||||
Monnet [54] | 500 ml of 0.9% saline over 30 minutes | Responders: >15% VO2 increase | 0 | Mean | +1,000 ml/min/m2 | -2 | +7 | +1% | -1.9 | -7 | ||
500 ml of 0.9% saline over 30 minutes | Non-responders: <15% increase in VO2 | 0 | Mean | +1,000 ml/min/m2 | +0 | +13 | +7% | -0.3 | -6 | |||
Schnell [62] | 500 ml of 0.9% saline over 15-30 minutes | Responders: >10% increase in aortic blood flow | 0 | Median | +20 ml/beat | -10 | +7 | |||||
500 ml of 0.9% saline over 15-30 minutes | Non-responders: <10% increase in aortic blood flow | 0 | Median | +8 ml/beat | -1 | +6 | ||||||
Sturgess [63] | 250 ml of 4% albumin over 15 minutes | All patients | 0 | Mean | +7.5% ml/beat | |||||||
Haemodynamic indices measured 30 minutes after fluid bolus administration
| ||||||||||||
Freitas [40] | 7 ml/kg, maximum 500 ml, of 6% HES over 30 minutes | Responders: >15% CO increase | 30 | Mean | +2,100 ml/min | -2 | +11 | +3 | +8% | -0.1 | ||
7 ml/kg, maximum 500 ml, of 6% HES over 30 minutes | Non-responders: <15% increase in CO | 30 | Mean | +200 ml/min | +0 | +8 | +5 | -3.5% | -0.2 | |||
Pierrakos [59] | 500 ml of 6% HES or 1,000 ml of CSL over 30 minutes | Responders: >10% increase in CI | 30 | Mean | +600 ml/min/m2 | -4 | +8 | +3 | +3% | |||
500 ml of 6% HES or 1,000 ml of CSL over 30 minutes | Non-responders: <10% increase in CI | 30 | Mean | +0 ml/min/m2 | -4 | +3 | +2 | +0% | ||||
Pottecher [60] | Up to 500 ml of 6% HES or 0.9% saline over 30 minutes | All patients | 30 | Mean | +1,400 ml/min | -2 | +7 | |||||
Wacharasint [66] | 500 ml of 6% HES over 30 minutes | All patients | 30 | Mean | +470 ml/min/m2 | +0.3 | +9.2 | +5.25 | ||||
van Haren [65] | 250 ml of 6% HES in 7.2% saline over 15 minutes | Hypertonic bolus | 30 | Mean | +300 ml/min/m2 | -11 | +4 | +2 | -0.2 | -8 | ||
500 ml of 6% HES in 0.9% saline over 15 minutes | Isotonic bolus | 30 | Mean | -400 ml/min/m2 | -1 | +5 | +4 | -0.1 | -9 | |||
Haemodynamic indices measured 60 minutes after fluid bolus administration
| ||||||||||||
Bihari [36] | 500-750 ml of 4% albumin, blood, 20% albumin FFP, 0.9% saline, 4% gelatin or platelets administered over less than 30 minutes | All patients | 60 | Median | +0 | +2 | +2 | +0.4% | -0.2 | No change | -6 | |
Ospina-Tascon [57] | 400 ml of 4% albumin or 1,000 ml of CSL over 30 minutes | Patients with early sepsis | 60 | Median | +300 ml/min/m2 | +2 | +2 | +3 | +2% | -0.2 | ||
400 ml of 4% albumin or 1,000 ml of CSL over 30 minutes | Patients with late sepsis | 60 | Median | +300 ml/min/m2 | -9 | +7 | +1 | +1% | +0.1 | |||
van Haren [65] | 250 ml of 6% HES in 7.2% saline over 15 minutes | Hypertonic bolus | 60 | Mean | +400 ml/min/m2 | -11 | +6 | +1 | -0.3 | -9 | ||
500 ml of 6% HES in 0.9% saline over 15 minutes | Isotonic bolus | 60 | Mean | -300 ml/min/m2 | -1 | +3 | +3 | -0.1 | -12 | |||
Haemodynamic indices measured greater than 60 minutes after fluid bolus administration
| ||||||||||||
van Haren [65] | 250 ml of 6% HES in 7.2% saline over 15 minutes | Hypertonic bolus | 120 | Mean | +300 ml/ml/m2 | -7 | +7 | +2 | 0.0 | +13 | -6 | |
500 ml of 6% HES in 0.9% saline over 15 minutes | Isotonic bolus | 120 | Mean | -300 ml/min/m2 | +0 | +1 | +2 | -0.3 | -30 | -9 | ||
250 ml of 6% HES in 7.2% saline over 15 minutes | Hypertonic bolus | 180 | Mean | +100 ml/min/m2 | -3 | +6 | +3 | -0.3 | -9 | |||
500 ml of 6% HES in 0.9% saline over 15 minutes | Isotonic bolus | 180 | Mean | +0 ml/min/m2 | +3 | +5 | +3 | -0.2 | -6 | |||
250 ml of 6% HES in 7.2% saline over 15 minutes | Hypertonic bolus | 240 | Mean | +100 ml/min/m2 | +1 | +3 | +3 | -0.3 | -3 | -8 | ||
500 ml of 6% HES in 0.9% saline over 15 minutes | Isotonic bolus | 240 | Mean | -200 ml/min/m2 | +3 | +0 | +3 | -0.2 | -40 | -4 |
Immediately post-infusion
Thirty minutes post-administration
Sixty minutes post-administration
Comparing responders and non-responders
Additional comparisons
Relationship between physiological changes after fluid bolus therapy and clinical outcome
First author | Journal | Year | Control group | ICU mortality | Hospital mortality | Other | Intervention group | ICU mortality | Hospital mortality | Other |
---|---|---|---|---|---|---|---|---|---|---|
Quality and Safety in Health Care
| 2010 | Before protocolised resuscitation | 19/37 | After protocolised resuscitation | 10/37 | |||||
Intensive Care Medicine
| 2012 | Responders (>10% increase in CI) | 13/25 | Non-responders (<10% increase in CI) | 11/26 | |||||
Annals of Pharmacotherapy
| 2010 | Pre-intervention | 32/53 | Post-intervention, significantly more fluid and less vasoactives | 12/59 | |||||
Critical Care Medicine
| 2010 | Pre-intervention | 51/96 | 55/96 | Post-intervention, significantly more fluid | 117/384 | 144/384 | |||
Critical Care Medicine
| 2012 | Pulmonary artery catheter-guided resuscitation | 13/34 | 15/34 | Transpulmonary thermodilution-guided resuscitation | 17/38 | 21/38 | |||
Supportive Care in Cancer
| 2013 | Pre-intervention | 28-day: 38/100 | Post-intervention, significantly quicker resuscitation | 28-day: 20/100 | |||||
Critical Care Medicine
| 2012 | Pre-intervention | 30-day: 126/245 | Post-intervention, significantly quicker resuscitation with significantly larger volumes of fluid at 6 and 24 hours | 30-day: 257/426 |
First author | Journal | Year | Control group | LOS in ICU (days) | LOS in hospital (days) | MV (days) | CRRT | Intervention group | LOS in ICU (days) | LOS in hospital (days) | MV (days) | CRRT |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Quality and Safety in Health Care
| 2010 | Before protocolised resuscitation | 8 | After protocolised resuscitation | 7 | |||||||
Critical Care Medicine
| 2010 | Pre-intervention | 9.9 | 26.5 | Intervention group, significantly more receive fluid | 9.1 | 30.6 | |||||
Supportive Care in Cancer
| 2013 | Pre-intervention | 5.1 | 10.3 | Post-intervention, significantly quicker resuscitation | 2.5 | 8.1 | |||||
Critical Care Medicine
| 2012 | Pulmonary artery catheter-guided resuscitation | 15 | 25 | 13 | Transpulmonary thermodilution-guided resuscitation | 11 | 27 | 10 | |||
Annals of Pharmacotherapy
| 2010 | Pre-intervention | 6 | 9.5 | 7.5 | 8/53 | Post-intervention, significantly more fluid and less vasoactives | 5 | 9 | 7 | 0/59 |