Mini fluid chAllenge aNd End-expiratory occlusion test to assess flUid responsiVEness in the opeRating room (MANEUVER study)

Abstract Background Mini-fluid challenge of 100 ml colloids is thought to predict the effects of larger amounts of fluid (500 ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100 ml) could predict the effects of 250 ml crystalloid in mechanically ventilated patients in the operating room. Methods A total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250 ml saline 0.9%) was given to maximize cardiac output during surgery. Stroke volume index (monitored using pulse contour analysis) and pulse pressure variations were recorded before and after 50 ml infusion (given for 1 min), after another 50 ml infusion (given for 1 min), and finally after 150 ml infusion (total = 250 ml). Changes in stroke volume index induced by 50, 100, and 250 ml were recorded. Positive fluid challenges were defined as an increase in stroke volume index of 10% or more from baseline after 250 ml. Results A total of 88 fluid challenges were performed (32% of positive fluid challenges). Changes in stroke volume index induced by 100 ml greater than 6% (gray zone between 4 and 7%, including 19% of patients) predicted fluid responsiveness with a sensitivity of 93% (95% CI, 77 to 99%) and a specificity of 85% (95% CI, 73 to 93%). The area under the receiver operating curve of changes in stroke volume index induced by 100 ml was 0.95 (95% CI, 0.90 to 0.99) and was higher than those of changes in stroke volume index induced by 50 ml (0.83 [95% CI, 0.75 to 0.92]; P = 0.01) and pulse pressure variations (0.65 [95% CI, 0.53 to 0.78]; P < 0.005). Conclusions Changes in stroke volume index induced by rapid infusion of 100 ml crystalloid predicted the effects of 250 ml crystalloid in patients ventilated mechanically in the operating room.

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Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness

Critical Care ◽

10.1186/s13054-019-2545-z ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 5

Author(s):

Antonio Messina ◽

Antonio Dell’Anna ◽

Marta Baggiani ◽

Flavia Torrini ◽

Gian Marco Maresca ◽

...

Keyword(s):

Systematic Review ◽

Fluid Responsiveness ◽

Fluid Challenge ◽

Occlusion Test

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End-Expiratory Occlusion Test Predicts Fluid Responsiveness in Patients With Protective Ventilation in the Operating Room

Anesthesia & Analgesia ◽

10.1213/ane.0000000000002322 ◽

2017 ◽

Vol 125 (6) ◽

pp. 1889-1895 ◽

Cited By ~ 25

Author(s):

Matthieu Biais ◽

Mathilde Larghi ◽

Jeremy Henriot ◽

Hugues de Courson ◽

Musa Sesay ◽

...

Keyword(s):

Operating Room ◽

Fluid Responsiveness ◽

Protective Ventilation ◽

Occlusion Test

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Changes in arterial blood pressure characteristics following an extrasystolic beat or a fast 50 ml fluid challenge do not predict fluid responsiveness during cardiac surgery

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-021-00722-z ◽

2021 ◽

Author(s):

Jonas M. Berg ◽

Dorthe V. Nielsen ◽

Vijoleta Abromaitiene ◽

Niels E. Hjørnet ◽

Simon T. Vistisen

Keyword(s):

Blood Pressure ◽

Cardiac Surgery ◽

Fluid Responsiveness ◽

Arterial Blood Pressure ◽

Fluid Challenge ◽

Predict Fluid Responsiveness ◽

Arterial Blood ◽

Pressure Characteristics

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Non-invasive assessment of fluid responsiveness to guide fluid therapy in patients with sepsis in the emergency department: a prospective cohort study

Emergency Medicine Journal ◽

10.1136/emermed-2020-209771 ◽

2021 ◽

pp. emermed-2020-209771

Author(s):

Nienke K Koopmans ◽

Renate Stolmeijer ◽

Ben C Sijtsma ◽

Paul A van Beest ◽

Christiaan E Boerma ◽

...

Keyword(s):

Cohort Study ◽

Fluid Responsiveness ◽

Prospective Cohort Study ◽

Fluid Therapy ◽

Prospective Cohort ◽

Fluid Challenge ◽

Fluid Bolus ◽

Non Invasive ◽

Similar Patient ◽

Passive Leg Raise

BackgroundLittle is known about optimal fluid therapy for patients with sepsis without shock who present to the ED. In this study, we aimed to quantify the effect of a fluid challenge on non-invasively measured Cardiac Index (CI) in patients presenting with sepsis without shock.MethodsIn a prospective cohort study, CI, stroke volume (SV) and systemic vascular resistance (SVR) were measured non-invasively in 30 patients presenting with sepsis without shock to the ED of a large teaching hospital in the Netherlands between May 2018 and March 2019 using the ClearSight system. After baseline measurements were performed, a passive leg raise (PLR) was done to simulate a fluid bolus. Measurements were then repeated 30, 60, 90 and 120 s after PLR. Finally, a standardised 500 mL NaCl 0.9% intravenous bolus was administered after which final measurements were done. Fluid responsiveness was defined as >15% increase in CI after a standardised fluid challenge.Measurements and main resultsSeven out of 30 (23%) patients demonstrated a >15% increase in CI after PLR and after a 500 mL fluid bolus. Fluid responders had a higher estimated glomerular filtration rate (eGFR) (64 (44–78) vs 37 (23–47), p=0.009) but otherwise similar patient and treatment characteristics as non-responders. Baseline measurements of cardiac output (CO), CI, SV and SVR were unrelated to PLR fluid responsiveness. The change in CI after PLR was strongly positive correlated to the change in CI after a 500 mL NaCl 0.9% fluid bolus (r=0.88, p<0.001).ConclusionThe results of the present study demonstrate that in patients with sepsis in the absence of shock, three out of four patients do not demonstrate a clinically relevant increase in CI after a standardised fluid challenge. Non-invasive CO monitoring in combination with a PLR test has the potential to identify patients who might benefit from fluid resuscitation and may contribute to a better tailored treatment of these patients.

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Intraoperative Assessment of Fluid Responsiveness in Normotensive Dogs under Isoflurane Anaesthesia

Veterinary Sciences ◽

10.3390/vetsci8020026 ◽

2021 ◽

Vol 8 (2) ◽

pp. 26

Author(s):

Despoina Skouropoulou ◽

Luca Lacitignola ◽

Caterina Di Bella ◽

Marzia Stabile ◽

Claudia Acquafredda ◽

...

Keyword(s):

Fluid Responsiveness ◽

Systolic Pressure ◽

Fluid Challenge ◽

Pressure Variation ◽

Before And After ◽

Ringer’S Lactate ◽

Controlled Mechanical Ventilation ◽

Variability Index ◽

Plethysmographic Variability Index ◽

Volume Controlled

The aim of this study was to evaluate the incidence of fluid responsiveness (FR) to a fluid challenge (FC) in normotensive dogs under anaesthesia. The accuracy of pulse pressure variation (PPV), systolic pressure variation (SPV), stroke volume variation (SVV), and plethysmographic variability index (PVI) for predicting FR was also evaluated. Dogs were anaesthetised with methadone, propofol, and inhaled isoflurane in oxygen, under volume-controlled mechanical ventilation. FC was performed by the administration of 5 mL/kg of Ringer’s lactate within 5 min. Cardiac index (CI; L/min/m2), PPV, (%), SVV (%), SPV (%), and PVI (%) were registered before and after FC. Data were analysed with ANOVA and ROC tests (p < 0.05). Fluid responsiveness was defined as 15% increase in CI. Eighty dogs completed the study. Fifty (62.5%) were responders and 30 (37.5%) were nonresponders. The PPV, PVI, SPV, and SVV cut-off values (AUC, p) for discriminating responders from nonresponders were PPV >13.8% (0.979, <0.001), PVI >14% (0.956, <0.001), SPV >4.1% (0.793, <0.001), and SVV >14.7% (0.729, <0.001), respectively. Up to 62.5% of normotensive dogs under inhalant anaesthesia may be fluid responders. PPV and PVI have better diagnostic accuracy to predict FR, compared to SPV and SVV.

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Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066617752308 ◽

2018 ◽

Vol 35 (4) ◽

pp. 354-363 ◽

Cited By ~ 12

Author(s):

Daniele Orso ◽

Irene Paoli ◽

Tommaso Piani ◽

Francesco L. Cilenti ◽

Lorenzo Cristiani ◽

...

Keyword(s):

Inferior Vena Cava ◽

Fluid Responsiveness ◽

Inferior Vena ◽

Data Extraction ◽

Meta Analysis ◽

Vena Cava ◽

Fluid Challenge ◽

Area Under The Curve ◽

Ultrasound Evaluation ◽

Caval Index

Objective: Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is needed. In this purpose, in recent years, the assessment of the inferior vena cava (IVC) through ultrasound (US) has become very popular. The aim of our work was to systematically review all the previously published studies assessing the accuracy of the diameter of IVC or its respiratory variations measured through US in predicting fluid responsiveness. Data Sources: We searched in the MEDLINE (PubMed), Embase, Web of Science databases for all relevant articles from inception to September 2017. Study Selection: Included articles specifically addressed the accuracy of IVC diameter or its respiratory variations assessed by US in predicting the fluid responsiveness in critically ill ventilated or not, adult or pediatric patients. Data Extraction: We included 26 studies that investigated the role of the caval index (IVC collapsibility or distensibility) and 5 studies on IVC diameter. Data Synthesis: We conducted a meta-analysis for caval index with 20 studies: The pooled area under the curve, logarithmic diagnostic odds ratio, sensitivity, and specificity were 0.71 (95% confidence interval [CI]: 0.46-0.83), 2.02 (95% CI: 1.29-2.89), 0.71 (95% CI: 0.62-0.80), and 0.75 (95% CI: 0.64-0.85), respectively. Conclusion: An extreme heterogeneity of included studies was highlighted. Ultrasound evaluation of the diameter of the IVC and its respiratory variations does not seem to be a reliable method to predict fluid responsiveness.

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