Assessment of volume responsiveness during mechanical ventilation: recent advances

Monnet, Xavier; Teboul, Jean‐Louis

doi:10.1186/cc12526

Cited by 140 publications

(94 citation statements)

References 61 publications

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“…Instead, dynamic tests of fluid responsiveness, such as the respiratory variation of pulse pressure or the inferior vena cava distensibility, are suitable predictors [8]. Thus, the dynamic assessment of fluid responsiveness might optimize intravascular volume and contribute to the improvement of outcomes in septic shock [8]. In our study, all patients with persistent or recurrent hypoperfusion received additional fluid boluses after the initial fluid load.…”

Section: Discussionmentioning

confidence: 93%

“…Central venous and pulmonary wedge pressures are misleading indicators of this response [46]. Instead, dynamic tests of fluid responsiveness, such as the respiratory variation of pulse pressure or the inferior vena cava distensibility, are suitable predictors [8]. Thus, the dynamic assessment of fluid responsiveness might optimize intravascular volume and contribute to the improvement of outcomes in septic shock [8].…”

Section: Discussionmentioning

confidence: 99%

“…For this analysis, we considered all dynamic tests as a whole. Although the tests are quite different from one another, they share the same underlying principle: to mimic the effect of a fluid bolus on stroke volume [8]. For this purpose, these tests take into account heartlung interactions during mechanical ventilation or the response to postural changes.…”

Section: Discussionmentioning

confidence: 99%

“…Given that both insufficient and excessive administration of solutions might be harmful, fluid management in sepsis should be carefully optimized. For this purpose, the use of dynamic predictors of fluid responsiveness might be especially beneficial [8][9][10]. These tests anticipate that a fluid challenge will result in an increase of cardiac output > 15%, without the risk of volume overload.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin

Loudet

Edul

et al. 2020

Ann. Intensive Care

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Background: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality.Methods: Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis.Results: Initially, 584 of 787 patients (74%) had mean arterial pressure (MAP) < 65 mm Hg and/or signs of hypoperfusion and received 30 mL/kg of fluids, mostly normal saline (53%) and Ringer lactate (35%). Vasopressors and/ or inotropes were administered in 514 (65%) patients, mainly norepinephrine (100%) and dobutamine (9%); in 22%, vasopressors were administered before ending the fluid load. After this, 413 patients (53%) presented persisting or recurrent hypotension and/or hypoperfusion, which prompted administration of additional fluid, based on: lactate levels (66%), urine output (62%), heart rate (54%), central venous O 2 saturation (39%), central venous-arterial PCO 2 difference (38%), MAP (31%), dynamic tests of fluid responsiveness (30%), capillary-refill time (28%), mottling (26%), central venous pressure (24%), cardiac index (13%) and/or pulmonary wedge pressure (3%). Independent predictors of mortality were SOFA and Charlson scores, lactate, requirement of mechanical ventilation, and utilization of dynamic tests of fluid responsiveness. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin

Loudet

Edul

et al. 2020

Ann. Intensive Care

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“…Minimally invasive methods based upon stroke volume variation (SVV) and pulse pressure variation (PPV) are increasingly used in the general ICU; in patients who are spontaneously breathing, these methods have limited utility. [29][30][31] However, these methods have failed to demonstrate acceptable accuracy in cirrhotic patients undergoing liver transplantation, which further questions their role in the ICU. 31 A pulmonary artery catheter may be useful in the management of complex cases in which fluid management is critical, such as patients with respiratory failure or when clinical or radiological findings do not allow differentiation of high-pressure versus low-pressure pulmonary edema and pulmonary infection, in patients with suspected right ventricular dysfunction, or in patients with pulmonary hypertension.…”

Section: Management Of Circulatory Failure Monitoring Circulatory Stamentioning

confidence: 99%

Management of Acute-on-Chronic Liver Failure

Durand

2016

Semin Liver Dis

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Acute-on-chronic liver failure (ACLF) is defined by the occurrence of organ failure(s) other than the liver in patients with cirrhosis. Even though mortality rates are high, there should no longer be reluctance to admit patients with ACLF in the intensive care unit. The prevalence of multidrug-resistant bacteria is high and broad spectrum antibiotics should be initiated as soon as infection is suspected. In patients with circulatory failure, the assessment of circulatory status is challenging due to the hyperkinetic state and an imbalance between the splanchnic and systemic blood volume. Acute kidney injury is common in patients with ACLF. Acute tubular necrosis should be differentiated from hepatorenal syndrome, which justifies vasoconstrictive agents. Renal replacement therapy and mechanical ventilation should be decided on clinical grounds. Recent trials on extracorporeal liver support failed to demonstrate a survival benefit. Aggressive management may serve as a bridge to transplantation provided patients are likely to survive after transplantation.

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Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?

Bentzer

Griesdale

Boyd

et al. 2016

JAMA

259

211

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Assessment of volume responsiveness during mechanical ventilation: recent advances

Cited by 140 publications

References 61 publications

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Management of Acute-on-Chronic Liver Failure

Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?

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