Mini-fluid challenge predicts fluid responsiveness during spontaneous breathing under spinal anaesthesia

Guinot, Pierre-Grégoire; Bernard, E.; Defrancq, Fanny; Petiot, S.; Majoub, Yazine; Dupont, Hervé; Lorne, Emmanuel

doi:10.1097/eja.0000000000000175

Cited by 49 publications

(41 citation statements)

References 19 publications

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“…In contrast with our study, Muller et al chose colloids, which are known to increase CO more than crystalloids 19,20 , the VTI may also be more sensitive and less dependent on accuracy of arterial catheters and, much more importantly, Muller and colleagues studied patients with acute circulatory failure where all the normal cardiac reflexes may not work properly. Guinot and colleagues 21 reported a similar study using crystalloids and measuring the change in SV by thoracic impedance cardiography. A dSV of 7% after 100 mL of crystalloids showed a sensitivity of 89 %, specificity of 89 % with a negative predictive value of 93%.…”

Section: Discussionmentioning

confidence: 95%

Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study

Aya

Rhodes

Ster

et al. 2017

Critical Care Medicine

100

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Objective: The objectives of this study are to determine what is the minimal volume required to perform an effective fluid challenge (FC) and to investigate how different doses of intravenous fluids in a FC affect the changes in cardiac output and the proportion of responders and non-responders.Design: quasi-randomised controlled trial. Setting: Cardiothoracic intensive care unit, tertiary university hospitalPatients: 80 Post-cardiac surgery patients.Intervention: intravenous infusion of 1, 2, 3 or 4 mL/Kg (body weight) of crystalloid over 5 minutes.Measurements: Mean systemic filling pressure measured using the transient stop-flow arm arterial-venous equilibrium pressure (Pmsf-arm), arterial and central venous pressure (CVP), cardiac output (CO; LiDCOplus, LiDCO, Cambridge, UK) and heart rate. Results:The groups were well matched with respect to demographic and baseline physiological variables.The proportion of responders increased from 20% in the group of 1mL/kg to 65% in the group of 4 mL/kg (p = 0.04). The predicted minimal volume required for a FC was between 321 to 509 mL. Only 4 mL/Kg increase Pmsf-arm beyond the limits of precision and was significantly associated with a positive response (OR 7.73, 95% CI 1.78 to 31.04). Conclusion:The doses of fluids used for a FC modify the proportions of responders in postoperative patients. A dose of 4 ml/Kg increases Pmsf-arm and reliably detects responders and non-responders.

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Section: Discussionmentioning

confidence: 95%

Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study

Aya

Rhodes

Ster

et al. 2017

Critical Care Medicine

100

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“…More recently, smaller fluid boluses have been tested; Wu et al showed that a mini-fluid challenge of 50 ml crystalloid in mechanically ventilated critically ill patients was associated with a 17% increase in stroke volume [41]. Guinot et al demonstrated that a mini-fluid challenge of 100 ml crystalloid in spontaneously breathing patients under spinal anaesthesia 'predicted' fluid responsiveness, with a 'grey zone' ranging between 3 and 8% [54]. This could potentially decrease the cardiac filling pressures and limit the deleterious effects of fluid among nonresponders [55].…”

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confidence: 99%

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

et al. 2015

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SummaryAccurate assessment of intravascular fluid status and measurement of fluid responsiveness have become increasingly important in peri-operative medicine and critical care. The objectives of this systematic review and narrative synthesis were to discuss current controversies surrounding fluid responsiveness and describe the merits and limitations of the major cardiac output monitors in clinical use today in terms of usefulness in measuring fluid responsiveness. We searched the MEDLINE and EMBASE databases (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015); inclusion criteria included comparison with an established reference standard such as pulmonary artery catheter, transthoracic echocardiography and transoesophageal echocardiography. Examples of clinical measures include static (such as central venous pressure) and dynamic (such as stroke volume variation and pulse pressure variation) parameters. The static parameters measured were described as having little value; however, the dynamic parameters were shown to be good physiological determinants of fluid responsiveness. Due to heterogeneity of the methods and patient characteristics, we did not perform a meta-analysis. In most studies, precision and limits of agreement (bias AE1.96SD) between determinants of fluid responsiveness measured by different devices were not evaluated, and the definition of fluid responsiveness varied across studies. Future research should focus on the physiological principles that underlie the measurement of fluid responsiveness and the effect of different volume expansion strategies on outcomes.

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“…8,25 Baseline CVP was higher in fluid non-responders, possibly indicating the presence of right ventricular dysfunction, compared to fluid responders. First, 22 controlled mechanically ventilated cardiac surgery patients with a regular heart rhythm were studied, so the results of this pilot study are certainly not generalizable to all ICU patients.…”

Section: Magder Et Al Showed That the Respiratorymentioning

confidence: 99%

Ventilator‐induced central venous pressure variation can predict fluid responsiveness in post‐operative cardiac surgery patients

Cherpanath

Geerts

Maas

et al. 2016

Acta Anaesthesiol Scand

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Mini-fluid challenge predicts fluid responsiveness during spontaneous breathing under spinal anaesthesia

Abstract: ΔSV100 greater than 7% accurately predicted fluid responsiveness during surgery with a grey zone ranging between 3 and 8%.

Cited by 49 publications

References 19 publications

Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study

Hemodynamic Effect of Different Doses of Fluids for a Fluid Challenge: A Quasi-Randomized Controlled Study

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

Ventilator‐induced central venous pressure variation can predict fluid responsiveness in post‐operative cardiac surgery patients

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