title: Fluid bolus therapy in emergency department patients: Indications and physiological changes.
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.
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. biharishailesh@gmail.com, biha0002@flinders.edu.au.|Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia. biharishailesh@gmail.com, biha0002@flinders.edu.au.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Bihari
authors.affiliation: Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia.|Department of Emergency Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Teubner
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Shivesh
authors.initials: S
authors.lastname: Prakash
authors.affiliation: Department of Emergency Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beatty
authors.affiliation: Department of Emergency Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Morphett
authors.affiliation: Department of Intensive Care, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.|The University of Melbourne, Melbourne, Victoria, Australia.|Monash University, Melbourne, Victoria, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.|Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bersten
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: blood pressure; emergency department; fluid bolus; fluid responder; respiratory rate; shock