Fluid responsiveness in acute circulatory failure

Hasanin, Ahmed

doi:10.1186/s40560-015-0117-0

Cited by 42 publications

(35 citation statements)

References 90 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fluid responsiveness is defined as the ability of the patient to increase the cardiac output (CO) in response to fluid administration. The aim of evaluation of fluid responsiveness is to discriminate patients who will benefit from fluid administration, so that to avoid unnecessary administration of fluids in non-responders [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?

Hasanin

Mostafa

2020

J Anesth

Self Cite

View full text Add to dashboard Cite

Non-protocolized fluid administration in critically ill patients, especially those with acute respiratory distress syndrome (ARDS), is associated with poor outcomes. Therefore, fluid administration in patients with Coronavirus disease (COVID-19) should be properly guided. Choice of an index to guide fluid management during a pandemic with mass patient admissions carries an additional challenge due to the relatively limited resources. An ideal test for assessment of fluid responsiveness during this pandemic should be accurate in ARDS patients, economic, easy to interpret by junior staff, valid in patients in the prone position and performed with minimal contact with the patient to avoid spread of infection. Patients with COVID-19 ARDS are divided into two phenotypes (L phenotype and H phenotype) according to their lung compliance. Selection of the proper index for fluid responsiveness varies according to the patient phenotype. Heart-lung interaction methods can be used only in patients with L phenotype ARDS. Real-time measures, such a pulse pressure variation, are more appropriate for use during this pandemic compared to ultrasound-derived measures, because contamination of the ultrasound machine can spread infection. Preload challenge tests are suitable for use in all COVID-19 patients. Passive leg raising test is relatively better than mini-fluid challenge test, because it can be repeated without overloading the patient with fluids. Trendelenburg maneuver is a suitable alternative to the passive leg raising test in patients with prone position. If a cardiac output monitor was not available, the response to the passive leg raising test could be traced by measurement of the pulse pressure or the perfusion index. Preload modifying maneuvers, such as tidal volume challenge, can also be used in COVID-19 patients, especially if the patient was in the gray zone of other dynamic tests. However, the preload modifying maneuvers were not extensively evaluated outside the operating room. Selection of the proper test would vary according to the level of healthcare in the country and the load of admissions which might be overwhelming. Evaluation of the volume status should be comprehensive; therefore, the presence of signs of volume overload such as lower limb edema, lung edema, and severe hypoxemia should be considered beside the usual indices for fluid responsiveness.

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?

Hasanin

Mostafa

2020

J Anesth

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients in similar clinical situations do not all respond in the same way to volume expansion. The ability to evaluate and predict an individual patient’s response to fluid therapy7 is a constant clinical challenge 8. When administration of fluids is mandatory, a parameter that could guide decision-making, balancing the risk of fluid overload against the benefits of volume expansion,9 would be the key to patient-tailored management.…”

Section: Introductionmentioning

confidence: 99%

Pulse wave velocity and short-term outcome in patients requiring intravascular volume expansion: a pilot study

et al. 2019

View full text Add to dashboard Cite

BackgroundFluid therapy has a pivotal role in the management of acutely ill patients. However, whether or not a patient can tolerate additional intravascular volume is controversial and optimal strategy is unknown. Carotid femoral pulse wave velocity (cfPWV) evaluates arterial stiffness.ObjectiveTo determine whether cfPWV can predict the ability of patients to tolerate clinically indicated acute fluid expansion.Methods50 consecutive patients requiring intravascular volume expansion were prospectively recruited in intensive care units. All subjects underwent transthoracic echocardiography, pulmonary ultrasound assessment, and a cfPWV study (S. Giovanni Bosco Hospital in Turin, Italy, between 2015 and 2016) at baseline and after 24 hours. Acute outcomes were registered at 24 hours (“soft” end points) and 30 days ('hard' end points: death, acute myocardial infarction, stroke, occurrence of atrial fibrillation, need for dialysis) after initial fluid therapy. Multivariate logistic regression was used to assess association of the initial cfPWV with outcomes.ResultscfPWV was significantly higher (10.6±3.6 vs 7.4±2.2 m/s, P<0.0001) in subjects who met the prespecified combined endpoints (hard or soft) than in those who did not. After adjustment for confounding factors, initial cfPWV was significantly and independently associated with the occurrence of hard events (OR=2.8 (95% CI 1.36 to 5.97), P=0.005; area under the receiver operating characteristic curve 84%). cfPWV of <9 m/s had a negative predictive value of 93%, excluding hard events associated with fluid expansion.ConclusioncfPWV appears to reflect the ability of the patient to tolerate an intravascular fluid expansion when clinically indicated. Increased cfPWV could help to identify subjects at greater risk of developing signs and symptoms of fluid overload.

show abstract

“…Fluid responsiveness is defined as the ability of the left ventricle to increase stroke volume (SV) after fluid administration. [1,2] Several methods have been suggested to detect fluid responsiveness. Of these methods, some that depend on heart −lung interactions have been shown to be effective during intraoperative management of liver transplantation patients.…”

Section: Introductionmentioning

confidence: 99%

Validity of Mini-Fluid Challenge for Predicting Fluid Responsiveness Following Liver Transplantation

Mukhtar

Awad

Elayashy

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant. Methods Fifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion. Results Fifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5–0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6–0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups. Conclusion A mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis Trial Registration Number NCT03396159. (Prospective registered). Initial registration date was 10/01/2018

show abstract

Fluid responsiveness in acute circulatory failure

Cited by 42 publications

References 90 publications

Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?

Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?

Pulse wave velocity and short-term outcome in patients requiring intravascular volume expansion: a pilot study

Validity of Mini-Fluid Challenge for Predicting Fluid Responsiveness Following Liver Transplantation

Contact Info

Product

Resources

About