Tuesday, June 4, 2019

Fluid boluses

PulmCrit (EMCrit)
PulmCrit - June 3, 2019 - By Josh Farkas 
..."Summary:The Bullet:
  • Fluid boluses don’t necessarily provide reliable information about the patient’s hemodynamics (especially if they are provided casually and without precise hemodynamic monitoring).
  • As shown below, the majority of fluid boluses don’t lead to sustained clinical benefit.
  • Risks of fluid bolus therapy include damage to the endothelial glycocalyx and volume overload.
  • Available RCTs involving fluid bolus treatment suggest that it is harmful.
  • Overall, fluid boluses may lead to transient improvements in hemodynamics, which reinforces the practice of providing them. However, a more detailed evaluation of the evidence and physiology suggests that most fluid boluses probably lead to harm.
  • The widely-recommended practice of treating anyone with potential infection and possible “sepsis” with a 30 cc/kg fluid bolus is likely dangerous and not evidence-based."