title: Characteristics and expectations of fluid bolus therapy: a bi-national survey of acute care physicians.
abstract: There is little consensus on the definition or optimal constituents of fluid bolus therapy (FBT), and there is uncertainty regarding its physiological effects. The aims of this study were to determine clinician-reported definitions of FBT and to explore the physiological responses clinicians expect from such FBT. In June and October 2014, intensive care and emergency physicians in Australia and New Zealand were asked to participate in an electronic questionnaire of the reported practice and expectations of FBT. Two hundred and fifty-one questionnaires were completed, 65.3% from intensivists. We identified the prototypical FBT given by intensivists is more than 250 ml of compound sodium lactate, saline or 4% albumin given in less than 30 minutes, while that given by emergency department physicians is a similar volume of saline delivered over a similar time frame. Intensive care and emergency physicians expected significantly different changes in mean arterial pressure (P=0.001) and heart rate (P=0.033) following FBT. Substantial variation was demonstrated in the magnitude of expected response within both specialties for each variable. Major variations exist in self-reported FBT practice, both within and between acute specialties, and wide variation can be demonstrated in the expected physiological responses to FBT. International explorations of practice and prospective quantification of the actual physiological response to FBT are warranted.
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria.
authors.forename: N J
authors.initials: NJ
authors.lastname: Glassford
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria.
authors.forename: S L
authors.initials: SL
authors.lastname: Jones
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria.
authors.forename: J
authors.initials: J
authors.lastname: Martensson
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria.
authors.forename: G M
authors.initials: GM
authors.lastname: Eastwoods
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University Prahran, Victoria.
authors.forename: M
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Department of Emergency Medicine, Box Hill Hospital, Box Hill, Victoria.
authors.forename: A M
authors.initials: AM
authors.lastname: Cross
authors.affiliation: Department of Emergency Medicine, Austin Hospital, Heidelberg, Victoria.
authors.forename: D McD
authors.initials: DM
authors.lastname: Taylor
authors.affiliation: Department of Intensive Care, Austin Hospital, Heidelberg, Victoria.
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D003422:Critical Care; D004632:Emergency Medical Services; D005440:Fluid Therapy; D006801:Humans
keywords: critical care; fluid bolus therapy; fluid resuscitation; haemodynamic optimisation