Validity of mini-fluid challenge for predicting fluid responsiveness following liver transplantation

Abstract

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 NCT03396159 . (Prospective registered). Initial registration date was 10/01/2018.

A comparative study of pulse pressure variation, stroke volume variation and central venous pressure in patients undergoing kidney transplantation

“…Recent literature suggests that ‘mini-fluid challenges’ can provide similar information as larger fluid challenges. [ 40 41 ] Further studies are needed to validate the reliability of several preload indexes for predicting fluid responsiveness using ‘mini-fluid challenges’ in KT recipients.…”

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

“…Use of a mini-fluid challenge to test for a cardiac preload reserve can reduce the risk of fluid overload that would otherwise occur with the administration of a traditional fluid challenge. In critically ill adult humans, rapid administration of 50-150 ml of fluids during 10 s to 2 min reasonably predicts the response to larger volumes of fluids (250-500 ml) (50)(51)(52)(53)(54)(55). In children undergoing elective surgery, however, a 3 ml/kg mini-fluid challenge administered during 2 min weakly predicted the effects of a 15 ml/kg volume of lactated Ringer's solution (LRS) (56).…”

“…Cardiac output and SV values derived from transthoracic or transesophageal echocardiography have been used to discriminate responders from non-responders to volume expansion in the human medical field ( 25 , 51 , 53 , 95 , 110 ) and in dogs ( 13 , 18 ). Because SV will change only as a function of changes in aortic flow, percent changes in aortic flow VTI have been used as a surrogate of SV to evaluate fluid responsiveness status in humans ( 36 , 50 , 56 , 111 ) and dogs ( 12 , 17 , 19 ).…”