Primary fluid bolus therapy for infection-associated hypotension in the emergency department

Objectives: The physiological changes associated with fluid bolus therapy (FBT) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. Methods: We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP) <100mmHg who underwent FBT in the first 6 hours. Results: We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBT volume given was 1570mL (interquartile range, 1000?2490mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66mmHg [SD, 10mmHg]) to its value at 6 hours (73mmHg [SD, 12mmHg]; P <0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P 100mmHg in 40 of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.