A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy

Huang, Daozheng; Ma, Huan; Ma, Jie; Hong, Liyan; Lian, Xihua; Wu, Yanhua; Wu, Yan Yan; Wang, Shouhong; Qin, Tiehe; Tan, Ning

doi:10.21037/atm.2020.04.56

Cited by 2 publications

(3 citation statements)

References 37 publications

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“…Little similar studies were found according to our findings except the one published by our team last year which focused on volume changes during blood pumpout test at the early stage of continued blood purification [5]. Umgelter et al reported that general hemodynamic parameters, such as heart rate, mean arterial pressure, and central venous pressure did not change after infusion of 200 ml of 20% albumin.…”

Section: Discussionsupporting

confidence: 82%

“…The future direction of fluid management would have a setting specific aim if we could tell the insufficient volume at the end of RRT. We have already found that the blood pump-out test at the initial procedure of RRT could serve as a complementary maneuver to predict fluid responsiveness [ 5 ]. Blood return has a similar effect on fluid expansion due to about 200 ml of blood going back to the body.…”

Section: Introductionmentioning

confidence: 99%

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Changes of cardiac output and velocity time integral in blood return at the end of renal replacement therapy predict fluid responsiveness in critically Ill patients with acute circulatory failure

Huang

Wang

et al. 2023

BMC Anesthesiol

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Objectives To observe if blood return, also defined as the blood infusion test (BIT) could predict fluid responsiveness in critically ill patients with acute circulatory failure and renal replacement therapy (RRT). Methods This was a single-center, prospective, diagnostic accuracy study. Before BIT, the passive leg raise test (PLRT) was performed to record the change of cardiac output (ΔCO) by pulse contour analysis, and ΔCO > = 10% was defined as the fluid responder. Meanwhile, the change in velocity time integral (ΔVTI) was recorded by ultrasound. Later, the ΔCO and ΔVTI during BIT were recorded 5–10 min after PLRT. The receiver-operating characteristic curves of ΔCO and ΔVTI of BIT were performed in predicting the fluid responder defined by PLRT. Results A total of 43 patients with acute circulatory failure undergoing RRT were enrolled in the present study, and 25 patients (58.1%) were recognized as responders during PLRT. According to the receiver-operating characteristic curves, the cutoff value of ΔCO was 10% and ΔVTI was 9% during BIT with the area under curve of 0.96 and 0.94, respectively. Conclusions BIT in RRT could identify fluid responsiveness in critically ill patients with shock. Trial registration ChiCTR-DDD-17010534. Registered on 30/01/2017 (retrospective registration).

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Changes of cardiac output and velocity time integral in blood return at the end of renal replacement therapy predict fluid responsiveness in critically Ill patients with acute circulatory failure

Huang

Wang

et al. 2023

BMC Anesthesiol

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“…1 ). Even if at the priming of the extracorporeal circuit, a decrease in CO is much more frequent in the case of preload responsiveness than in the case of preload unresponsiveness [ 104 ], other factors may be responsible for intra-dialytic hypotension. However, the fact remains that the existence of a preload responsiveness must urge not to withdraw additional fluid.…”

Section: Introductionmentioning

confidence: 99%

How I personalize fluid therapy in septic shock?

2023

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During septic shock, fluid therapy is aimed at increasing cardiac output and improving tissue oxygenation, but it poses two problems: it has inconsistent and transient efficacy, and it has many well-documented deleterious effects. We suggest that there is a place for its personalization according to the patient characteristics and the clinical situation, at all stages of circulatory failure. Regarding the choice of fluid for volume expansion, isotonic saline induces hyperchloremic acidosis, but only for very large volumes administered. We suggest that balanced solutions should be reserved for patients who have already received large volumes and in whom the chloremia is rising. The initial volume expansion, intended to compensate for the constant hypovolaemia in the initial phase of septic shock, cannot be adapted to the patient’s weight only, as suggested by the Surviving Sepsis Campaign, but should also consider potential absolute hypovolemia induced by fluid losses. After the initial fluid infusion, preload responsiveness may rapidly disappear, and it should be assessed. The choice between tests used for this purpose depends on the presence or absence of mechanical ventilation, the monitoring in place and the risk of fluid accumulation. In non-intubated patients, the passive leg raising test and the mini-fluid challenge are suitable. In patients without cardiac output monitoring, tests like the tidal volume challenge, the passive leg raising test and the mini-fluid challenge can be used as they can be performed by measuring changes in pulse pressure variation, assessed through an arterial line. The mini-fluid challenge should not be repeated in patients who already received large volumes of fluids. The variables to assess fluid accumulation depend on the clinical condition. In acute respiratory distress syndrome, pulmonary arterial occlusion pressure, extravascular lung water and pulmonary vascular permeability index assess the risk of worsening alveolar oedema better than arterial oxygenation. In case of abdominal problems, the intra-abdominal pressure should be taken into account. Finally, fluid depletion in the de-escalation phase is considered in patients with significant fluid accumulation. Fluid removal can be guided by preload responsiveness testing, since haemodynamic deterioration is likely to occur in patients with a preload dependent state.

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A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy

Cited by 2 publications

References 37 publications

Changes of cardiac output and velocity time integral in blood return at the end of renal replacement therapy predict fluid responsiveness in critically Ill patients with acute circulatory failure

Changes of cardiac output and velocity time integral in blood return at the end of renal replacement therapy predict fluid responsiveness in critically Ill patients with acute circulatory failure

How I personalize fluid therapy in septic shock?

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