Why Is a Fluid Bolus Administered and Has There Been a Change in Practice? Results from SAFE, SAFE TRIPS and Fluid TRIPS Dataset

Rationale Despite their frequent use in critically ill patients and evidence of harm, surprisingly little has been reported with regards to two fundamental questions around practice of fluid bolus administrations - why a fluid bolus is administered in intensive care patients and has the emerging evidence changed practice? This information would be vital for translational research. We examined the large datasets with the SAFE (2003), SAFE TRIPS (2007) and Fluid TRIPS (2014) to examine practice over time. Methods Data from SAFE (2003), SAFE TRIPS (2007) and Fluid TRIPS (2014) was accessed from The George Institute for Global health Australia after appropriate approvals. Demographic data, baseline hemodynamic data and indications of fluid boluses were extracted and examined from these datasets. Both parametric and non-parametric comparisons were done. Data is presented as mean and standard deviation or median and interquartile range based on the distribution of the data. Results Data from 6851, 1684 and 1456 patient s were available from the SAFE (2003), SAFE TRIPS(2007) and Fluid TRIPS (2014) datasets respectively. There was an increase in age of patients with the more recent datasets[58.5 (18.9) vs 60.9 (17.3) vs 61.5 (17.5) years; p<0.01], while the severity of illness (APACHE II) was 18.8 (8.0) vs 16.2 (8.6) vs18.8 (9.1). The average mean arterial blood pressure (mmHg) was lower and central venous pressure (mm Hg) higher with themore recent datasets (78.0 (16.4) vs 75.3 (17.4) vs 73.9 (18.0), p<0.001; 8.6 (4.7) vs 9.6 (5.3) vs 9.4 (5.3), p<0.001)respectively. While examining the reason for administering a fluid bolus, low blood pressure was the most common cause inall three datasets and there was increase in frequency in the most recent datasets. Simultaneously, there was a decrease inthe use of other signs such as high heart rate, low CVP, low urine output, capillary refill time as an indication for fluid bolus inthe recent dataset of SAFE TRIPS AND FLUID TRIPS (Table) Conclusion - Low blood pressure is the most common reasonfor a fluid bolus across the examined time line, however there has been a decrease in the use of other clinical indicators suchas low CVP, high heart rate, low urine output and impaired capillary refill time with the more recent datasets. This mightindicate a change of practice over time with the administration of fluid boluses.