The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review

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. ME...

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Bibliographic Details
Published in:Scandinavian journal of trauma, resuscitation and emergency medicine resuscitation and emergency medicine, 2017-03, Vol.25 (1), p.25-25, Article 25
Main Authors: Elwan, Mohammed H, Roshdy, Ashraf, Elsharkawy, Eman M, Eltahan, Salah M, Coats, Timothy J
Format: Article
Language:English
Subjects:
Accuracy
Adult
Bias
Content analysis
Critical care
Diagnostic tests
Emergency medical care
Emergency Service, Hospital
Feasibility studies
Fluid Therapy
Hemodynamics
Humans
Mortality
Patients
Review
Systematic review
Ventilators
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Summary: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. MEDLINE, Embase and the Cochrane library were searched for relevant peer-reviewed studies published from 1946 to present. 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. 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.
ISSN:1757-7241
1757-7241
DOI:10.1186/s13049-017-0370-4