title: The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review.
abstract: BACKGROUND
  Fluid therapy is a common and crucial treatment in the emergency department (ED). While fluid responsiveness seems to be a promising method to titrate fluid therapy, the evidence for its value in ED is unclear. We aim to synthesise the existing literature investigating fluid responsiveness in ED.
  
  
  METHODS
  MEDLINE, Embase and the Cochrane library were searched for relevant peer-reviewed studies published from 1946 to present.
  
  
  RESULTS
  A total of 249 publications were retrieved of which 22 studies underwent full-text review and eight relevant studies were identified. Only 3 studies addressed clinical outcomes - including 2 randomised controlled trials and one feasibility study. Five articles evaluated the diagnostic accuracy of fluid responsiveness techniques in ED. Due to marked heterogeneity, it was not possible to combine results in a meta-analysis.
  
  
  CONCLUSIONS
  High quality, adequately powered outcome studies are still lacking, so the place of fluid responsiveness in ED remains undefined. Future studies should have standardisation of patient groups, the target response and the underpinning theoretic concept of fluid responsiveness. The value of a fluid responsiveness based fluid resuscitation protocol needs to be established in a clinical trial.
authors.affiliation: Department of Emergency Medicine, Alexandria University, Alexandria, Egypt. mohammed.elwan@alexmed.edu.eg.|Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Level G Jarvis Building RMO, Infirmary Square, LE1 5WW, Leicester, UK. mohammed.elwan@alexmed.edu.eg.
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Elwan
authors.affiliation: Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt.|General Intensive Care Unit, Broomfield hospital, Mid Essex NHS Trust, Chelmsford, UK.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Roshdy
authors.affiliation: Department of Cardiology, Alexandria University, Alexandria, Egypt.
authors.forename: Eman M
authors.initials: EM
authors.lastname: Elsharkawy
authors.affiliation: Department of Cardiology, Alexandria University, Alexandria, Egypt.
authors.forename: Salah M
authors.initials: SM
authors.lastname: Eltahan
authors.affiliation: Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Level G Jarvis Building RMO, Infirmary Square, LE1 5WW, Leicester, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans
keywords: Cardiac output; Emergency; Fluid responsiveness; Fluid therapy; Haemodynamics; Resuscitation; Shock