Abstract
BackgroundThe fluid challenge is considered the gold standard for diagnosis of fluid responsiveness. The objective of this study was to describe the fluid challenge techniques reported in fluid responsiveness studies and to assess the difference in the proportion of ‘responders,’ (PR) depending on the type of fluid, volume, duration of infusion and timing of assessment.MethodsSearches of MEDLINE and Embase were performed for studies using the fluid challenge as a test of cardiac preload with a description of the technique, a reported definition of fluid responsiveness and PR. The primary outcome was the mean PR, depending on volume of fluid, type of fluids, rate of infusion and time of assessment.ResultsA total of 85 studies (3601 patients) were included in the analysis. The PR were 54.4% (95% CI 46.9–62.7) where <500 ml was administered, 57.2% (95% CI 52.9–61.0) where 500 ml was administered and 60.5% (95% CI 35.9–79.2) where >500 ml was administered (p = 0.71). The PR was not affected by type of fluid. The PR was similar among patients administered a fluid challenge for <15 minutes (59.2%, 95% CI 54.2–64.1) and for 15–30 minutes (57.7%, 95% CI 52.4–62.4, p = 1). Where the infusion time was ≥30 minutes, there was a lower PR of 49.9% (95% CI 45.6–54, p = 0.04). Response was assessed at the end of fluid challenge, between 1 and 10 minutes, and >10 minutes after the fluid challenge. The proportions of responders were 53.9%, 57.7% and 52.3%, respectively (p = 0.47).ConclusionsThe PR decreases with a long infusion time. A standard technique for fluid challenge is desirable.
Highlights
The fluid challenge is considered the gold standard for diagnosis of fluid responsiveness
We included studies meeting the following inclusion criteria: use of a fluid challenge as a test of cardiac preload or as part of a clinical algorithm, studies performed in Intensive care unit (ICU) or operating theatres with adult patients, studies including a full description of the fluid challenge technique, studies which included a clear definition of fluid responsiveness, and studies where the numbers of responders and non-responders to the fluid challenge were stated
We excluded studies involving pregnant women and children, studies where more than one fluid challenge was performed in the same patient, studies involving passive leg raising without use of a fluid challenge technique, studies where more than one fluid type was used whilst reporting a single result, studies using a continuous infusion of fluid, and studies where the fluid responsiveness was assessed only after a period of 60 minutes or more following completion of fluid challenge
Summary
The fluid challenge is considered the gold standard for diagnosis of fluid responsiveness. The objective of this study was to describe the fluid challenge techniques reported in fluid responsiveness studies and to assess the difference in the proportion of ‘responders,’ (PR) depending on the type of fluid, volume, duration of infusion and timing of assessment. Intravenous fluid is one of the most commonly administered therapies for critically ill patients and is the cornerstone of haemodynamic management of patients in intensive care units (ICUs) [1]. Fluid responsiveness may depend on the particularities of the fluid challenge, including the type and volume of fluid as well as the administration rate. Administration of a fluid challenge is not a standardised technique, with varying volumes, infusion rates, fluid types and durations of response. Whilst different clinical conditions may require different fluid challenge techniques, there is heterogeneity in practice for the same clinical condition [6]
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