Abstract
BackgroundFluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC.MethodsThis is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC.ResultsFrom May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43–63], median SOFA score 10 [8–12]). Among the 76/143 (53%) patient responders to FC at T10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T30 (49%, 95%CI = [37–60]), and 39 (51%, 95%CI = [38–62]) patients were persistent responders (PR), i.e., remained responders at T30. Among the 67 NR at T10, 4 became responders at T30, (6%, 95%CI = [1.9–15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups.ConclusionsThis study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent.Trial registrationClinicalTrials.gov, NCT02116413. Registered on April 16, 2014
Highlights
Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU)
Fluid challenge assessment Fluid challenge induced a > 15% increase in velocity time integral (VTI) in 76/143 patients (53%) at T10 (Fig. 3)
Among these 76 responders, 37 changed their fluid responsiveness status from R to NR at T30 (48.7%, 95%CI = [37.2–60.3]). These patients were defined as transient responders (TR)
Summary
Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). Adequate fluid resuscitation is a key issue as both hypovolemia and fluid overload are associated with poor outcome in intensive care unit (ICU) [2,3,4]. Despite consistent data published over the last decades, Roger et al Critical Care (2019) 23:179 positive response to fluid therapy (fluid responsiveness) is defined as a 10–15% SV or CO increase immediately after 250 to 500 ml of fluid infusion [1, 11]. Beyond immediate response to fluid infusion, the efficacy of a fluid bolus over time is affected by various parameters such as blood volume status, cardiac function, type of infused fluid, and capillary leak severity [14]. We could imagine that a patient initially identified as a fluid responder could no longer be responder 30 min after fluid infusion, leading to discrepancies in fluid management decision-making
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