Accuracy of cumulative volumes of fluid challenge to assess fluid responsiveness in critically ill patients with acute circulatory failure: a pharmacodynamic approach.
circulatory failure
critical care medicine
dose–effect
dose–response
fluid challenge
fluid responsiveness
oesophageal Doppler
pharmacodynamics
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
30
06
2021
revised:
11
10
2021
accepted:
12
10
2021
pubmed:
14
12
2021
medline:
16
2
2022
entrez:
13
12
2021
Statut:
ppublish
Résumé
The relationship between the dose (volume of fluid) and the effect (increase of stroke volume [SV]) has been poorly described. We hypothesised that the analysis of the dynamic response of SV during fluid challenge (FC) helps to determine the optimal volume of FC, along with its diagnostic accuracy parameters for fluid responsiveness. A prospective observational study was conducted in critically ill patients with circulatory failure. Patients monitored with oesophageal Doppler and assigned to an FC of 500 ml of crystalloid were included. The areas under the curve (AUC) and 95% confidence intervals (CI Forty-five patients were included. The AUC increased with cumulative volumes of FC up to 250 ml (AUC A volume of FC of 250 ml with a threshold of 9.6% increase in SV showed the highest accuracy in detecting fluid responsiveness in critically ill patients with shock. .
Sections du résumé
BACKGROUND
BACKGROUND
The relationship between the dose (volume of fluid) and the effect (increase of stroke volume [SV]) has been poorly described. We hypothesised that the analysis of the dynamic response of SV during fluid challenge (FC) helps to determine the optimal volume of FC, along with its diagnostic accuracy parameters for fluid responsiveness.
METHODS
METHODS
A prospective observational study was conducted in critically ill patients with circulatory failure. Patients monitored with oesophageal Doppler and assigned to an FC of 500 ml of crystalloid were included. The areas under the curve (AUC) and 95% confidence intervals (CI
RESULTS
RESULTS
Forty-five patients were included. The AUC increased with cumulative volumes of FC up to 250 ml (AUC
CONCLUSIONS
CONCLUSIONS
A volume of FC of 250 ml with a threshold of 9.6% increase in SV showed the highest accuracy in detecting fluid responsiveness in critically ill patients with shock.
CLINICAL TRIAL REGISTRATION
BACKGROUND
.
Identifiants
pubmed: 34895718
pii: S0007-0912(21)00741-8
doi: 10.1016/j.bja.2021.10.049
pii:
doi:
Substances chimiques
Crystalloid Solutions
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
236-243Informations de copyright
Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.