A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

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• 作者：Yunfan Wu (8)
  Shusheng Zhou (8)
  Zhihua Zhou (9)
  Bao Liu (8)
  
  8. Department of Critical Care Medicine ; Affiliated Provincial Hospital of Anhui Medical University ; No. 17 ; Lujiang Road ; Hefei ; 230001 ; Anhui Province ; China
  9. Department of Critical Care Medicine ; Affiliated Hospital of Neurology Institute ; Anhui University of Traditional Chinese Medicine ; No. 357 ; Yangtze river middle road ; Hefei ; 230061 ; Anhui Province ; China
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：18
• 期：3
• 全文大小：637 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction The accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. Non-invasive evaluation of fluid responsiveness by the rapid infusion of a very limited amount of volume is an important clinical goal. This study aimed to test whether echocardiographic parameters could predict fluid responsiveness in critically ill patients following a low-volume (50-ml crystalloid solution) infusion over 10鈥塻econds. Methods We prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10鈥塻econds and a further 450鈥塵l over 15鈥塵inutes. Cardiac output (CO), stroke volume (SV), aortic velocity time index (VTI), and left ventricular ejection fraction (LVEF) were recorded. Patients were classified as responders (Rs) if CO increased by at least 15% following the 500-ml volume expansion or were classified as non-responders (NRs) if CO increased by less than 15%. Area under the receiver operating characteristic curves (AUC) compared CO variations after 50鈥塵l over 10鈥塻econds (鈭咰O50) and 500鈥塵l over 15鈥塵inutes (鈭咰O500) and the variation of VTI after infusion of 50鈥塵l of fluid over 10鈥塻econds (鈭哣TI50). Results In total, 50 patients were enrolled, and 27 (54%) of them were Rs. General characteristics, LVEF, heart rate, and central venous pressure were similar between Rs and NRs. In the Rs group, the AUC for 鈭咰O50 was 0.95鈥壜扁€?.03 (P r鈥?鈥?.87; P P r鈥?鈥?.72; P Conclusion In critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10鈥塻econds (鈭咰O50 and 鈭哣TI50) can accurately predict fluid responsiveness. Trial registration Current Controlled Trials ISRCTN10524328. Registered 12 December 2013.