What is a fluid challenge?

Cecconi, Maurizio; Parsons, Anthony K; Rhodes, Andrew

doi:10.1097/mcc.0b013e32834699cd

Cited by 191 publications

(135 citation statements)

References 37 publications

(39 reference statements)

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…When there is evidence of intravascular hypovolemia, a fluid challenge is recommended to test volume responsiveness. This should be given rapidly over five to ten minutes, 23 and although there is no consensus on the type of fluid given, most trials in the operating room showing an improved outcome were performed with a colloid. [24][25][26][27][28][29][30][31][32] Importantly, hemodynamic instability does not equate with volume responsiveness; indeed, only 50% of hemodynamically unstable patients in the operating room are ''volume responders''.…”

Section: Maintenance Fluid Therapymentioning

confidence: 99%

“…A fluid challenge can therefore identify and simultaneously treat volume depletion while avoiding deleterious consequences of fluid overload through its small volume and targeted administration. 23 Although the exact fluid challenge varies in the literature, it should be given over a short period of time (less than ten minutes) so that the response can be easily observed.…”

Section: Maintenance Fluid Therapymentioning

confidence: 99%

See 1 more Smart Citation

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

137

View full text Add to dashboard Cite

Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a ''zero-balance'' approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and ''permissive oliguria'' could be tolerated.Résumé La gestion périopératoire optimale des liquides est un élément important des programmes de récupération rapide après la chirurgie (RRAC). La gestion des liquides dans le cadre de la RRAC doit être vue comme un continuum au travers des phases pré-, per-et postopératoires. Chaque phase est importante pour améliorer la condition du patient et des soins sous-optimaux au cours d'une de ces phases peuvent miner les meilleures pratiques déployées tout au long de la RRAC. L'objectif de la gestion préopératoire des liquides est de faire en sorte que le patient entre en salle d'opération correctement hydraté et dans un état euvolémique. Pour y parvenir, un jeûne prolongé n'est pas recommandé et le nettoyage mécanique de l'intestin est à éviter. Les patients doivent être encouragés à absorber une boisson claire riche en hydrates de carbone, deux à trois heures avant la chirurgie. Les buts de la gestion peropératoire des liquides sont de maintenir une euvolémie centrale et d'éviter un excès de sel et d'eau. Pour y parvenir, les patients subissant une intervention chirurgicale dans le cadre d'un protocole de récupération rapide devraient avoir un programme personnalisé de gestion des liquides. Dans le cadre de ce plan, l'excès de cristalloïdes doit être évité chez tous les patients. Pour des patients à faible risque subissant une intervention c...

show abstract

Section: Maintenance Fluid Therapymentioning

confidence: 99%

Section: Maintenance Fluid Therapymentioning

confidence: 99%

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

Miller

Roche

Mythen

2014

Can J Anesth/J Can Anesth

225

137

View full text Add to dashboard Cite

show abstract

“…Importantly, a fluid challenge is not volume resuscitation; it is merely a test to identify those who are preload responsive. Volume responders can then be given additional fluid resuscitation with minimal risk for fluid overload (33). The effect of a fluid challenge can be better understood when taking into consideration the venous side of the circulation.…”

Section: For Preloadmentioning

confidence: 99%

Perioperative Haemodynamic Optimisation

Aya¹,

Cecconi²,

Rhodes³

2014

Turk J Anesth Reanim

Self Cite

View full text Add to dashboard Cite

56During the latest years, a number of studies have confirmed the benefits of perioperative haemodynamic optimisation on surgical mortality and postoperative complication rate. This process requires the use of advanced haemodynamic monitoring with the purpose of guiding therapies to reach predefined goals. This review aim to present recent evidence on perioperative goal directed therapy (GDT), with an emphasis in some aspects that may merit further investigation. In order to maximise the benefits on outcomes, GDT must be implemented as early as possible; intravascular volume optimisation should be in accordance with the response of the preload-reserve, goals should be individualised and adequacy of the intervention must be also assessed; non-invasive or minimally invasive monitoring should be used and, finally, side effects of every therapy should be taken into account in order to avoid undesired complications. New drugs and technologies, particularly those exploring the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of this group of therapeutic interventions.

show abstract

“…During dynamic tests of fluid responsiveness (i.e. passive leg raising [20] or fluid challenge [21] tests) pulse contour analysis can be a monitoring option allowing the continuous real-time monitoring of changes in CO. In addition, in the perioperative setting, pulse contour analysis-based monitoring can be indicated to apply goal-directed hemodynamic therapy [2,22].…”

mentioning

confidence: 99%