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Critical Care

Volume 18 Supplement 2

Sepsis 2014

Open Access

Physiological changes after fluid bolus therapy in sepsis: a systematic review of the contemporary literature

  • NJ Glassford1, 2,
  • GM Eastwood1, 3 and
  • R Bellomo1, 2
Critical Care201418(Suppl 2):P34

Published: 3 December 2014


Sodium ChlorideRandomise Control TrialSeptic ShockSevere SepsisPhysiological Effect


Fluid bolus therapy (FBT) is a ubiquitous intervention in intensive care. However, the physiological effects in the critically ill are poorly understood. Therefore, we systematically reviewed the contemporary literature to determine the current practice and effect of FBT in the management of severe sepsis and septic shock.


We interrogated the MEDLINE, CENTRAL and EMBASE electronic reference databases using a combination of terms to define a set of records of studies of fluid administration in patients with severe sepsis or septic shock. To achieve contemporary relevance, results were limited to English-language studies in adults between 2010 and 2013.


We identified 22 prospective observational studies, four retrospective observational studies, two quasi-experimental studies, and five randomised controlled trials (RCTs), 41 boluses in total. No RCT compared FBT with alternative interventions. The median fluid bolus was 500 ml (range: 100 to 1,000 ml) administered over 30 minutes (range: 10 to 60 minutes) and 0.9% sodium chloride solution was the most commonly administered. Although 17 studies describe the temporal course of physiological changes after FBT in 31 patient groups, only three studies describe the physiological changes at 60 minutes, and only one study beyond this point (Figure 1). No studies related the physiological changes after FBT with clinically relevant outcomes.
Figure 1

Haemodynamic changes following FBT at 1, 2, 3 and 4 hours.


There is a need for obtaining randomised controlled evidence for the physiological effects of FBT in patients with severe sepsis and septic shock beyond the period immediately following its administration.

Authors’ Affiliations

Department of Intensive Care, Austin Hospital, Heidelberg, Australia
ANZICS Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Australia


© Glassford et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.