Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?

Bentzer, Peter; Griesdale, Donald; Boyd, John H.; MacLean, Kelly A.; Sirounis, Demetrios; Ayas, Najib

doi:10.1001/jama.2016.12310

Cited by 250 publications

(244 citation statements)

References 93 publications

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“…PLR-induced changes in CO has been validated against a ‘gold standard’ fluid bolus in several meta-analyses [44, 47, 52, 53]. It showed a reasonable accuracy regardless of the monitoring method or ventilation mode (sensitivity 85–89%, specificity 91–92% and area under the curve 0.95).…”

Section: Discussionmentioning

confidence: 99%

The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review

Elwan

Roshdy

Elsharkawy

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundFluid therapy is a common and crucial treatment in the emergency department (ED). While fluid responsiveness seems to be a promising method to titrate fluid therapy, the evidence for its value in ED is unclear. We aim to synthesise the existing literature investigating fluid responsiveness in ED.MethodsMEDLINE, Embase and the Cochrane library were searched for relevant peer-reviewed studies published from 1946 to present.ResultsA total of 249 publications were retrieved of which 22 studies underwent full-text review and eight relevant studies were identified. Only 3 studies addressed clinical outcomes - including 2 randomised controlled trials and one feasibility study. Five articles evaluated the diagnostic accuracy of fluid responsiveness techniques in ED. Due to marked heterogeneity, it was not possible to combine results in a meta-analysis.ConclusionHigh quality, adequately powered outcome studies are still lacking, so the place of fluid responsiveness in ED remains undefined. Future studies should have standardisation of patient groups, the target response and the underpinning theoretic concept of fluid responsiveness. The value of a fluid responsiveness based fluid resuscitation protocol needs to be established in a clinical trial.

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Section: Discussionmentioning

confidence: 99%

The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review

Elwan

Roshdy

Elsharkawy

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…On the one hand, there is a tremendous amount of evidence that a given value of CVP does not predict fluid responsiveness. This has been established by a number of studies and meta-analyses [14, 16]. On the other hand, surveys regularly report that clinicians still continue to use CVP for predicting fluid responsiveness.…”

Section: Central Venous Pressure and Static Markers Of Cardiac Preloamentioning

confidence: 99%

“…This has been confirmed by several studies. To date, PPV is the marker of preload responsiveness that has accumulated the largest amount of evidence [14, 23, 24]. A recent meta-analysis which included 22 studies and 807 patients reported a pooled sensitivity for predicting fluid responsiveness of 88% with a specificity of 89%.…”

Section: Pulse Pressure and Stroke Volume Variation: Well-establishedmentioning

confidence: 99%

“…Accordingly, in healthy blood donors, it was not correlated with the cardiac output changes induced by blood removal [49]. The inferior vena cava diameter variation was found to be a poor predictor of fluid responsiveness in the emergency department where patients are usually spontaneously breathing [14, 50], although contradictory findings have been reported [51]. A recent study observed that, in patients with spontaneous breathing, only the respiratory variation of the inferior vena cava diameter of very high amplitude indicated fluid responsiveness [52].…”

Section: Variations Of Vena Caval Dimensionsmentioning

confidence: 99%

“…For this prediction, the method that has been used for decades, namely central venous pressure (CVP), has been demonstrated to be unreliable. Conversely, a number of “dynamic” methods have been developed to test preload responsiveness [14, 15]. In this review, we will summarise the most recent findings regarding this strategy of fluid management.

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Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prediction of fluid responsiveness: an update

Monnet

Marik

Teboul

2016

Ann. Intensive Care

443

359

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In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other “static” markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditional use should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload, using heart–lung interactions, the passive leg raise or by the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure and stroke volume variations were first developed, but they are reliable only under strict conditions. The variations in vena caval diameters share many limitations of pulse pressure variations. The passive leg-raising test is now supported by solid evidence and is more frequently used. More recently, the end-expiratory occlusion test has been described, which is easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluid overload. The dynamic tests are complementary, and clinicians should choose between them based on the status of the patient and the cardiac output monitoring technique. Several methods and tests are currently available to identify preload responsiveness. All have some limitations, but they are frequently complementary. Along with elements indicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in a reasoned way.

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