Prediction of fluid responsiveness: a review

Enev, Rostislav; Krastev, Plamen; Abedinov, Filip

doi:10.1080/13102818.2021.1960190

Cited by 6 publications

(6 citation statements)

References 50 publications

(55 reference statements)

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“…Fluid administration in response to intraoperative oliguria can lead to diuresis. 15,21 Neither the oliguria nor the intraoperative diuresis seem to predict post-operative renal failure (defined as need of dialysis) in elective surgical patients. However, further studies are needed to confirm it.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

Pardeep Kumar,

Asthana,

Shweta Bhardwaj

et al. 2023

Asian J Med Sci

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Background: During the past 20 years, numerous publications have described the usefulness of systolic pressure variation, pulse pressure variation, stroke volume variation, etc., to guide intraoperative fluid administration. However, we still lack robust noninvasive physiological variables to successfully predict the response to fluid loading. Aims and Objectives: The present study was designed to evaluate the utility of plethysmography variability index (PVI) to optimize fluid management during intra-abdominal surgery in cancer patients. Materials and Methods: After the Institutional Ethics Committee approval and consent, 60 patients scheduled for elective lower abdominal cancer surgeries were randomized to receive fluid by either PVI-directed management (2 mL/kg/h) or using central venous pressure (8 mL/kg/h) after standardized technique of general and lumbar epidural anesthesia. The PVI was calculated by measuring changes in the PI during the respiratory cycle (PVI = [(PImax - PImin)/PImax] × 100). Arterial blood samples were taken at the time of incision and after 6 h postoperatively. Instances of intraoperative hypotension and oliguria were recorded. Results: Among the 60 patients enrolled in the study, demographic data, ASA status, duration of surgery, and hemodynamics were found to be comparable. The amount of crystalloid given was significantly lesser in Group P (984.70±51.16) as compared to Group C (2395.27±209.68) (P<0.001). Four patients in Group P and three patients in Group C required vasopressors. Conclusion: The use of PVI-guided fluid management was associated with lower lactate levels and crystalloid requirement. Reduced lactate levels in PVI-guided patients suggest that PVI-guided fluid management may be tailored to everyone’s needs.

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Section: Discussionmentioning

confidence: 99%

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

Pardeep Kumar,

Asthana,

Shweta Bhardwaj

et al. 2023

Asian J Med Sci

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“…< 8 mL kg -1 ) and neither PEEP nor driving pressure influences measurements [20,77]. However, other reviews and studies indicate that high TV ventila tion is required for accurate FR predictions [78][79][80][81]. When low TV ventilation is used, it has also been proposed to perform a tidal volume challenge.…”

Section: Dynamic Measurements Based On Heart-lung Interactionmentioning

confidence: 99%

Methods of assessing fluid responsiveness in septic shock patients: a narrative review

Weigl¹,

Adamski²,

Onichimowski³

et al. 2022

ait

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Septic shock, similar to other types of circulatory shock, is characterised by peripheral hypoperfusion and, consequently, inadequate tissue oxygen deli very. It is commonly believed that intravenous fluid infusion improves organ perfusion and reverses cel lular dysoxia. This belief might be valid in the early phase of septic shock, and some earlier studies [1] and international recommendations (Surviving Sepsis Campaign) [2] support this view. The physio logical rationale behind fluid bolus administration is that it causes intravascular volume expansion. According to the FrankStarling principle, increased left ventricular enddiastolic volume (i.e., preload) increases stroke volume (SV), resulting in improved organ perfusion. This mechanism works until the optimal preload is achieved. However, the patho physiology of septic shock is complex and compris es both distributive and cardiogenic components. At the peripheral level, the inflammatory process in sepsis damages the endothelial glycocalyx [3] and

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“…(5)(6)(7) Another approach, the mini-fluid challenge test, has accurately predicted fluid responsiveness using restricted fluid administration of a 100 mL colloid bolus. (7)(8)(9)(10) However, it is noted that the availability of colloids varies among hospitals, and they are generally more expensive compared to crystalloids, which are more available in hospitals. Real-time cardiac output or stroke volume measurement is necessary to determine the treatment effect of a fluid bolus after a challenge test.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Fluid Responsiveness With Crystalloid Mini-Fluid Challenge in Critically Ill Patients

Thongtaeparak,

Somboonviboon,

Lertamornpong

et al. 2024

J Southeast Asian Med Res

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Background: The mini-fluid challenge test is a good predictor and has minimal limitations in determining fluid responsiveness in the critically ill. However, it primarily relies on colloid infusion. The availability of colloids may vary among hospitals in resource-limited countries, and they can be more expensive than crystalloid fluids. Objective: The study aimed to use crystalloids instead of colloids to predict fluid responsiveness. Methods: This study was conducted from August 2022 to February 2023 among patients with shock in the medical ICU to assess fluid responsiveness. Arterial and central venous catheters were used for the intravenous infusion and monitoring. Data were collected during two consecutive crystalloid mini-fluid challenges of 50 mL each in 1 minute, 100 mL in 2 minutes, and a standard fluid challenge of 300 mL over 15 minutes. The objective was to predict a stroke volume index (SVI) increase of > 10%. Diagnostic accuracy was evaluated using the Receiver Operating Characteristic (ROC) curve, and hemodynamic variables in the positive fluid challenge group were compared for different volume expansions. Results: Twenty-nine patients (62% males; median age, 75 years) were included, with 42 fluid challenge test events. Septic shock was the primary condition in 83% of the cases. The 50 mL crystalloid mini-fluid challenge showed an accuracy of 80% with a sensitivity of 69% and specificity of 100% at the cutoff level of SVI > 5%, Area Under ROC (AUROC)=0.79. In comparison, the 100 mL crystalloid mini-fluid challenge demonstrated an accuracy of 85% (sensitivity of 79% and specificity of 100%) at the cutoff level of SVI > 10% (AUROC= 0.89). In the positive fluid challenge group, administration of crystalloids led to a significant increase in mean arterial pressure and SVI, while other parameters remained comparable. Conclusions: A mini-fluid challenge test with 100 mL crystalloids can predict fluid responsiveness in critically ill patients. The best cutoff level was a change in SVI > 10% from baseline.

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Prediction of fluid responsiveness: a review

Cited by 6 publications

References 50 publications

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

Methods of assessing fluid responsiveness in septic shock patients: a narrative review

Prediction of Fluid Responsiveness With Crystalloid Mini-Fluid Challenge in Critically Ill Patients

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