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Table 2 Description of fluid boluses, triggers, physiological end-points and primary confounders

From: Physiological changes after fluid bolus therapy in sepsis: a systematic review of contemporary data

First author

Year

Initial resuscitation

Bolus fluid type

Bolus fluid volume (ml)

Bolus fluid rate (minutes)

Physiological trigger for fluid administration

Physiological end-point for fluid administration

Number of boluses administered

Vasoactive administration?

Packed red cell transfusion?

Bihari [36]

2013

Undefined

4% albumin

750

<30

Clinician defined

Clinician defined

2

Yes

Not described

Packed red cells

20% albumin

Fresh frozen plasma

4% gelatin

0.9% saline

Castellanos-Ortega [37]

2010

Undefined

Crystalloid

1,000

30

Hypotension

CVP ≥8 mmHg, MAP ≥65 mmHg, ScvO2 ≥ 70%

Not described

Yes

Not described

Colloid

500

De Backer [38]

2010

500 ml colloid or 1,000 ml crystalloid

Crystalloid

1,000

Not defined

MAP <70 mmHg; SBP <100 mmHg, altered mental state; mottled skin; oliguria >1 hour, hyperlactataemia

Not described

Not described

Yes

Not described

Colloid

500

Dong [39]

2012

Undefined

6% HES

500

30

SBP <90 mmHg or >40 mmHg drop or need for vasopressors, oliguria >1 hour; mottled skin; HR >100 bpm

End of infusion.

1

Not described

Not described

Freitas [40]

2012

Undefined

6% HES

7 ml/kg (max 500)

30

Clinician defined

End of infusion

1

Yes

No

Gaieski [41]

2010

20-30 ml/kg

0.9% saline

500

15-20

CVP <8 mmHg

CVP >8 mmHg

Not described

Yes

Yes

Hamzaoui [42]

2010

Undefined

0.9% saline

1,000

Not defined

Undefined

Not described

Not described

Yes

Not described

Hanzelka [43]

2013

20 ml/kg

Undefined

1,000

60

Severe sepsis

SBP >90 mmHg, MAP <65 mmHg

Not described

Yes

No

500

30

Jacob [44]

2012

Undefined

0.9% saline

1,000

60

SBP <100 mmHg or hyperlactataemia

SBP increased by 10 mmHg for 2 consecutive hours to >90 mmHg

Up to 10

No

Not described

500

30

Khwannimit [45]

2012

Undefined

6% HES

500

30

Clinician defined

End of infusion

1

Yes

Not described

Lakhal [46]

2013

Undefined

4% gelatin

500

30

One or more of SBP <90 mmHg, MAP <65 mmHg , requiring vasoactive medication, oliguria, skin mottling, hyperlactataemia

End of infusion

1

Yes

Not described

Lanspa [47]

2012

5,060 ml

Crystalloid (or equivalent colloid)

20 ml/kg

<20

Clinician defined

End of infusion

1.36

Yes

Yes

Machare-Delgado [48]

2011

Undefined

0.9% saline

500

10

Clinician defined

End of infusion

1

Not described

No

MacRedmond [49]

2010

25 ml/kg

0.9% saline

500

<15

MAP <65 mmHg

CVP 8-12; MAP >65 mmHg; ScvO2 > 70%

Not described

Yes

Yes

Mahjoub [50]

2013

Undefined

0.9% saline

500

20

SBP <90 mmHg and/or need for vasoactive drugs and/or persistent lactic acidosis

End of infusion

1

Yes

Not described

McIntyre [51]

2012

2,400 ml

0.9% saline or 4% albumin

500

STAT

Undefined

Not described

6

Yes

Not described

Monnet [52]

2010

Undefined

0.9% saline

500

30

SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria

End of infusion

1

Yes

Not described

Monnet [53]

2011

2,200 ml

0.9% saline

500

10

SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria

End of infusion

1

Yes

Not described

Monnet [54]

2013

Undefined

0.9% saline

500

30

SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria

End of infusion

1

Yes

Yes

Monnet [55]

2011

Undefined

0.9% saline

500

20

SBP <90 mmHg, SBP drop >50 mmHg if HT, and one or more of HR >100, skin mottling or oliguria

End of infusion

1

Yes

Not described

O’Neill [56]

2012

20 ml/kg

0.9% saline

500

15

CVP <8 mmHg; MAP <65 mmHg; ScvO2 < 70%

CVP 8-12; MAP >65 mmHg; ScvO2 > 70%

0.68

Yes

Not described

Ospina-Tascon [57]

2010

Undefined

CSL

1,000

30

MAP <65 mmHg

End of infusion

1

Yes

Not described

4% albumin

400

Patel [58]

2010

2,000 ml

Normal saline

Undefined

30

SBP <90 mmHg; MAP <65 mmHg

Not described

1

Yes

Not described

Pierrakos [59]

2012

Undefined

CSL

100

30

Clinician defined

End of infusion

1

Yes

Not described

6% HES

500

Pottecher [60]

2010

Undefined

HES 6% or 0.9% saline

500

30

MAP <65 mmHg, skin mottling or oliguria

End of infusion

1

Yes

Not described

Sanchez [61]

2011

Undefined

Crystalloid

1,000

Undefined

Hypotension with perfusion abnormalities

 

Not described

Yes

No

Colloid

500

ITBVI >900 ml/ml or EVLWI >10 ml/kg

Schnell [62]

2013

Undefined

0.9% saline

500

15-30

Clinician defined

End of infusion

1

Yes

Not described

Sturgess [63]

2010

Undefined

4% albumin

250

15

Clinician defined

End of infusion

1

Yes

No

Trof [64]

2012

Undefined

HES or 4% gelatin

250-500

30

EVLWI <10 ml/kg or >10 ml/kg with GEDVI <850 ml/m2; PAOP >18 mmHg; MAP <65 mmHg, HR >100, SvO2 < 65% or ScvO2 < 70%; oliguria; peripheral perfusion deficits, hyperlactatemia

MAP >65 mmHg, ScvO2 > 70%, lactate clearance, diuresis >0.5 ml/kg/hour, restoration of peripheral perfusion deficits

3.48

Yes

Not described

van Haren [65]

2012

Undefined

6% HES in 0.9% saline

500

15

Septic shock

End of infusion

1

Yes

Not described

250

15

6% HES in 7.2% saline

Wacharasint [66]

2013

Undefined

HES 6%

500

30

SBP <90 mmHg or requirement for vasopressors

End of infusion

1

Yes

Not described

Yu [67]

2011

30 ml/kg in 1,000 ml increments

Crystalloid or colloid

250-500

Undefined

PAOP <12 mmHg or 12-17 mmHg with

SBP >100 mmHg, HR <100 bpm, UO >0.5 ml/kg/hour, lactate clearance, SmvO2 > 70%

Not described

Not described

Yes

SBP <100; HR >100 bpm UO <0.5 ml/kg/hour; hyperlactataemia; SvO2 > 70% or equivalent blood volume goals

Zhang [68]

2012

Undefined

Crystalloid or colloid

250-500

30

SBP <90 mmHg; HR >100 bpm; GEDVI <700 ml/m2; CVP <12 mmHg (PEEP dependent)

Pre-defined rise in CVP

Not described

Yes

Not described

  1. CSL, compound sodium lactate solution; CVP, central venous pressure; EVLWI, extra-vascular lung water index; HES, hydroxyethyl starch; HR, heart rate; HT, hypertensive; GEDVI, global end diastolic volume index; ITBVI, intrathoracic blood volume index; MAP, mean arterial blood pressure; PAOP, pulmonary artery occlusion pressure; PEEP, positive end-expiratory pressure; SBP, systolic blood pressure; ScvO2, central venous oxygen saturation; SmvO2, mixed venous oxygen saturations; STAT, statim/immediately; SvO2, venous oxygen saturation; UO, urine output.