Defining the Characteristics and Expectations of Fluid Bolus Therapy: A Worldwide Perspective

Abstract Purpose To understand what clinicians believe defines Fluid Bolus Therapy (FBT) and the expected response to such intervention. Methods We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT. Results We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 ml of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution respectively. The majority of respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase > 10 mmHg; a heart rate decrease > 10 beats/minute; an increase in urinary output by more than 10 ml/h, an increase in central venous oxygen saturation > 4% or a lactate decrease > 1 mmol/l. Conclusions Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT and identify a response to it. Further investigation is now required to describe actual FBT practice, to identify the magnitude and duration of the physiological response to FBT, and its relationship to patient-centred outcomes.