Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel...

Area of Science:

• Critical Care Medicine
• Emergency Medicine
• Fluid Resuscitation

Background:

• Fluid resuscitation is critical in managing shock, particularly in pre-intensive care unit (ICU) and resource-limited environments.
• Existing guidelines often focus on ICU settings, leaving gaps in evidence for other clinical scenarios.
• The European Society of Intensive Care Medicine (ESICM) convened a task force to address these evidence deficits.

Purpose of the Study:

• To systematically review evidence on fluid administration guided by basic monitoring, with a focus on pre-ICU and resource-limited settings.
• To address key questions regarding clinical assessment, required monitoring, fluid challenge parameters, and safety endpoints.
• To identify gaps in scientific evidence for fluid administration outside the operating theater.

Main Methods:

• Systematic review of evidence by an international expert task force.
• Focus on four core questions related to fluid resuscitation in shock.
• Emphasis on pre-ICU hospital settings and resource-limited environments.

Main Results:

• Insufficient evidence was found to provide recommendations using the GRADE system.
• Recommendations were limited to basic interventions based on available evidence and expert opinion.
• Significant gaps in scientific evidence for fluid administration outside the ICU (excluding the operating theater) were identified.

Conclusions:

• There is a critical need for research to address evidence gaps in basic fluid administration.
• Improved fluid administration strategies are needed for both resource-rich and resource-limited settings.
• Addressing these gaps will benefit patient outcomes and global health.