Published in:
Open Access
01-12-2017 | Review
The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review
Authors:
Mohammed H. Elwan, Ashraf Roshdy, Eman M. Elsharkawy, Salah M. Eltahan, Timothy J. Coats
Published in:
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
|
Issue 1/2017
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Abstract
Background
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.
Methods
MEDLINE, Embase and the Cochrane library were searched for relevant peer-reviewed studies published from 1946 to present.
Results
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.
Conclusion
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.