Related Experiment Video
Updated: Sep 7, 2025
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Fluid bolus administration in children, who responds and how? A systematic review and meta-analysis
Rohit S Loomba1,2, Enrique G Villarreal3, Juan S Farias3
1Cardiology, Advocate Children's Hospital, Chicago, Illinois, USA.
Insights
Fluid boluses improve blood pressure and cardiac output in over half of pediatric patients. Older children with lower cardiac index and stroke volume benefit most from these fluid administrations.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Fluid Resuscitation
Background:
- Fluid boluses are a common intervention in pediatric care.
- Objective data on fluid bolus utility and patient response is limited.
Purpose of the Study:
- To identify pediatric patients most likely to respond to fluid boluses.
- To characterize clinical changes associated with fluid bolus administration.
Main Methods:
- Systematic review and meta-analysis of pediatric studies.
- Inclusion of 15 studies with 637 patients.
Main Results:
- Greater age, lower cardiac index, and lower stroke volume at baseline predicted fluid bolus response.
- Fluid boluses significantly decreased heart rate and increased blood pressure, cardiac index, stroke volume, central venous pressure, and systemic vascular resistance.
Conclusions:
- Fluid boluses enhance blood pressure and cardiac output in approximately 56% of pediatric patients.
- Significant hemodynamic improvements observed, but data on systemic oxygen delivery remains limited.
Background:
Fluid boluses are frequently utilized in children. Despite their frequency of use, there is little objective data regarding the utility of fluid boluses, who they benefit the most, and what the effects are.
Aims:
This study aimed to conduct pooled analyses to identify those who may be more likely to respond to fluid boluses as well as characterize clinical changes associated with fluid boluses.
Methods:
A systematic review of the literature and meta-analysis was conducted to identify pediatric studies investigating the response to fluid boluses and clinical changes associated with fluid boluses.
Results:
A total of 15 studies with 637 patients were included in the final analyses with a mean age of 650 days ± 821.01 (95% CI 586 to 714) and a mean weight of 10.5 kg ± 7.19 (95% CI 9.94 to 11.1). The mean bolus volume was 12.14 ml/kg ± 4.09 (95% CI 11.8 to 12.5) given over a mean of 19.55 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [-0.5 ml/min/m2 (-0.9 to -0.3)], and lower stroke volume [-5.1 ml/m2 (-7.9 to -2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [-5.6 bpm (-9.8 to -1.3)], increased systolic blood pressure [7.7 mmHg (1.0 to 14.4)], increased mean arterial blood pressure [5.5 mmHg (3.1 to 7.8)], increased cardiac index [0.3 ml/min/m2 (0.1 to 0.6)], increased stroke volume [4.3 ml/m2 (3.5 to 5.2)], increased central venous pressure [2.2 mmHg (1.1 to 3.3)], and increased systemic vascular resistance [2.1 woods units/m2 (0.1 to 4.2)].
Conclusion:
Fluid blouses increase arterial blood pressure or cardiac output by 10% in approximately 56% of pediatric patients. Fluid blouses lead to significant decrease in HR and significant increases in cardiac output, stroke volume, and systemic vascular resistance. Limited published data are available on the effects of fluid blouses on systemic oxygen delivery.
Related Concept Videos
01:19One-Compartment Open Model for IV Bolus Administration: General Considerations
The drug's presence in the body is defined by an equation representing the difference between the rates of drug entry and exit. Key parameters—elimination rate constant,...
01:18Two-Compartment Open Model: IV Bolus Administration
The disparity between drug input and the sum of drug transfer rates between...
00:56One-Compartment Open Model for IV Bolus Administration: Estimation of Clearance
In the one-compartment open model for intravenous (IV) bolus administration, clearance is estimated by dividing the elimination rate by the plasma drug concentration. This equation leverages the elimination rate constant and the apparent...
01:21Factors Affecting Drug Response: Overview
01:09One-Compartment Open Model for IV Bolus Administration: Estimation of Elimination Rate Constant, Half-Life and Volume of Distribution
00:59Nonlinear Pharmacokinetics: Drug Elimination for IV Bolus Injection
Following the administration of a single intravenous (IV) bolus injection, we can determine the concentration of the drug in the plasma at any given time. This calculation is achieved using a specific equation that integrates the values of Vmax and KM.
We can also...