A Prospective Observational Study of the Expectations and Physiological Effects of Fluid Bolus Therapy

Study Overview
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Brief Summary
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This prospective observational study aims to (i) asses intensive care doctors trigger for and the expected physiological response to a fluid bolus and (ii) evaluate the patient's actual physiological response to a single fluid bolus at one hour post-bolus for 100 adult patients admitted to the intensive care unit will be included in the study.

Detailed Description
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Intensive care unit patients often receive a fluid bolus during their ICU-stay. ICU doctors use a variety of clinical triggers when deciding whether or not to give a fluid bolus. However, the type of physiological triggers used and their correlation to the anticipated physiological response of the patient to an administered fluid bolus is not entirely clear. The investigators will perform a prospective observational study to evaluate the triggers for, expected physiological and actual physiological response to fluid bolus therapy in the intensive care unit. Specifically, the investigators will assess which of the the physiological trigger(s) intensive care doctors use when deciding to give a fluid bolus; the expected physiological response to the fluid bolus by intensive care doctors; and, to what degree the patients actual physiological response 1 hour after a fluid bolus correlate with expectations. This study will involve a survey of ICU physicians to determine the physiological trigger and expectations and a medical audit to ascertain the physiological response to a fluid bolus. The investigators will evaluate a single fluid bolus in 100 separate intensive care unit patients.

Official Title
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A Prospective Observational Study of the Expectations and Physiological Effects of Fluid Bolus Therapy in the Intensive Care Unit

Conditions
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Hypovolemia, Sepsis, Post-operative Hypovolemia, Fluid Therapy

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted to the intensive care unit and prescribed a fluid bolus. Exclusion Criteria: The intensive care physician declines to participate. Expected survival < 24h

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy of anticipated hemodynamic effects at completion of bolus | The accuracy and precision between the expected and the observed physiological effects will be described using Bland-Altman methodology | At completion of bolus | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy of anticipated hemodynamic effects at one hour after completion of the fluid bolus | The accuracy and precision between the expected and the observed physiological effects will be described using Bland-Altman methodology | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on blood pressure at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on blood pressure one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on heart rate at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on heart rate one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on cardiac index at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on cardiac index one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on CVP at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on CVP one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on ScVO2 or SvO2 at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on ScVO2 or SvO2 one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on lactate levels at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on lactate levels one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 
| The hemodynamic effects of a fluid bolus at completion of bolus | The effect of the fluid bolus on urine output at completion of bolus will be described. | At completion of bolus | 
| The hemodynamic effects of a fluid bolus at one hour after completion of the fluid bolus | The effect of the fluid bolus on urine output one hour after completion of the fluid bolus will be described. | At one hour after completion of the fluid bolus | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fluid therapy