Abstract

IntroductionThe 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 seconds.MethodsWe prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10 seconds and a further 450 ml over 15 minutes. 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 ml over 10 seconds (∆CO50) and 500 ml over 15 minutes (∆CO500) and the variation of VTI after infusion of 50 ml of fluid over 10 seconds (∆VTI50).ResultsIn 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 ∆CO50 was 0.95 ± 0.03 (P <0.01; best cutoff value, 6%; sensitivity, 93%; specificity, 91%). Moreover, ∆CO50 and ∆CO500 were strongly correlated (r = 0.87; P <0.01). The AUC for ∆VTI50 was 0.91 ± 0.04 (P <0.01; best cutoff value, 9%; sensitivity, 74%; specificity, 95%). ∆VTI50 and ∆CO500 were positively correlated (r = 0.72; P <0.01).ConclusionIn critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10 seconds (∆CO50 and ∆VTI50) can accurately predict fluid responsiveness.Trial registrationCurrent Controlled Trials ISRCTN10524328. Registered 12 December 2013.

Highlights

  • The accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients

  • Patients Mechanically ventilated adults admitted to the intensive care unit (ICU) with hypovolemic shock, severe sepsis, or septic shock were included from March to October 2013

  • Significant differences in the following were predictive of fluid responsiveness: systolic blood pressure (SBP), velocity time index (VTI), stroke volume (SV), and cardiac output (CO)

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Summary

Introduction

The accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. 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 seconds. Multiple studies have demonstrated that static parameters have limited the predictive value for fluid responsiveness. These include pulmonary artery occlusion pressure, right ventricular end-diastolic volume, left ventricular enddiastolic volume, central venous pressure (CVP), and inferior vena cava (IVC) diameter [2,13,14,15]. Many studies have demonstrated that echocardiography [2,16,18,20] offers a non-invasive, dynamic, and qualitative assessment of volume responsiveness in patients with hemodynamic failure, such as changes in the velocity time integral

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