Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

Abstract

Resuscitative fluid therapy aims to increase stroke volume (SV) and cardiac output (CO) and restore/improve tissue oxygen delivery in patients with circulatory failure. In individualized goal-directed fluid therapy (GDFT), fluids are titrated based on the assessment of responsiveness status (i.e., the ability of an individual to increase SV and CO in response to volume expansion). Fluid administration may increase venous return, SV and CO, but these effects may not be predictable in the clinical setting. The fluid challenge (FC) approach, which consists on the intravenous administration of small aliquots of fluids, over a relatively short period of time, to test if a patient has a preload reserve (i.e., the relative position on the Frank-Starling curve), has been used to guide fluid administration in critically ill humans. In responders to volume expansion (defined as individuals where SV or CO increases ≥10–15% from pre FC values), FC administration is repeated until the individual no longer presents a preload reserve (i.e., until increases in SV or CO are <10–15% from values preceding each FC) or until other signs of shock are resolved (e.g., hypotension). Even with the most recent technological developments, reliable and practical measurement of the response variable (SV or CO changes induced by a FC) has posed a challenge in GDFT. Among the methods used to evaluate fluid responsiveness in the human medical field, measurement of aortic flow velocity time integral by point-of-care echocardiography has been implemented as a surrogate of SV changes induced by a FC and seems a promising non-invasive tool to guide FC administration in animals with signs of circulatory failure. This narrative review discusses the development of GDFT based on the FC approach and the response variables used to assess fluid responsiveness status in humans and animals, aiming to open new perspectives on the application of this concept to the veterinary field.

Fluid management in septic patients with pulmonary hypertension, review of the literature

“…As a patient approaches the plateau portion of the curve, atrial pressure increases which leads to increased venous and pulmonary hydrostatic pressures (56). The combined increase in pressures, along with increased natriuretic peptides, result in a shift of fluid from the intravascular to the interstitial space and ultimately leads to pulmonary and peripheral edema (57). Tissue edema impairs oxygen and metabolite diffusion, and distorts capillary blood flow with a profound effect on the venous pressure and function in vital organs (58).…”

Women Undergoing Goal-Directed Fluid Therapy During Pregnancy: A Systematic Review and Meta-Analysis of Published Randomized Controlled Trials

“…Our study has several strength points (1) we conducted all steps in strict accordance with the Cochrane Handbook of Systematic Reviews for interventions, (2) we followed the standard reporting guidelines of PRISMA statement to report this work, (3) we ran a comprehensive search of multiple electronic databases to identify all relevant studies, and finally (4) Our study reported class 1 evidence about the efficacy of GDFT during pregnancy. Nonetheless, our study has a few limitations.…”

“…Rapid volume expansion by administration of intravenous fluid is essential for patients undergoing major surgeries or patients with poor volume expansion as they need to maintain tissue perfusion [1] . One of the most efficient methods of intravenous therapy is goal-directed fluid therapy (GDFT) [2] .…”

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“…Total intravenous crystalloid infusion in the 24-hour postoperative period was derived from the medical record J Thorac Dis 2022;14 (7):2602-2610 | https://dx.doi.org/10.21037/jtd-22-707 and defined as the volume of crystalloid administered in the 24-hour postoperative period. Initially, patients were classified into four groups representing incremental quartiles of the exposure variable of the total intravenous crystalloid infusion in the 24-hour postoperative period (8,12).…”

“…Healthy people have a certain preload reserve capacity, and they have the ability to self-regulate on the ascending limb of the Frank-Starling curve without the need for additional fluid supplementation ( 7 ). Insufficient intravascular volume to patients who are fluid responsive can be adapted by self-adjustment, and excessive perioperative fluid administration to these patients may increase the risks of fluid overload without conferring additional benefit ( 8 , 9 ).…”