Predictive value of mini-fluid challenge for volume responsiveness_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HE Huiwei ,  YANG Chunli , HE Zhaohui , CHEN Zhi , XIA Wenhan

Department of Critical Care Medicine, Jiangxi Province People’s Hospital, Nanchang, Jiangxi 330006, P. R. China;

Corresponding?author：

YANG Chunli, Email: ycl121@163.com

Keywords：

Mini-fluid challenge; Pulse indicator continuous cardiac output; Volume responsiveness; Shock

DOI：

10.7507/1671-6205.201901057

Video：

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Objective To evaluate the predictive value of mini-fluid challenge for volume responsiveness in patients under shock.Methods Sixty patients diagnosed as shock were included in the study. A 50 mL infusion of physiological saline over 10 seconds and a further 450 mL over 15 minutes were conducted through the central venous catheter. Cardiac output (CO), global end-diastolic volume index (GEDVI), central venous pressure (CVP) and extravascular pulmonary water index (EVLWI) were monitored by the pulse indicator continuous cardiac output monitoring. If the increase of CO after 500 mL volume expansion (ΔCO₅₀₀) ≥10%, the patient was considered to be with volume responsiveness. The relevance between ΔCO₅₀ and ΔCO₅₀₀ was analyzed, and the sensitivity and specificity of the ΔCO₅₀ were analyzed by receiver operating characteristic (ROC) curve.Results After 50 mL volume injection, the heart rate and systolic blood pressure of the two groups did not change obviously. The CVP of non-responders changed slightly higher than that of responders, but neither of them had obviously difference (P>0.05). The CO of responders had increased significantly (P<0.05) which was in accord with that after a further 450 mL volume injection. GEDVI and EVLWI did not change significantly (P>0.05). ΔCO₅₀ and ΔCO₅₀₀ were strongly correlated (r=0.706, 95%CI 0.677 - 0.891, P>0.05). The area under ROC curve for ΔCO₅₀ was 0.814 (95%CI 0.707 - 0.922).Conclusion The volume responsiveness of patients under shock can be predicted by mini-fluid challenge study which is related to normal volume expansion and it does not increase the risk of pulmonary edema.

Citation： HE Huiwei, YANG Chunli, HE Zhaohui, CHEN Zhi, XIA Wenhan. Predictive value of mini-fluid challenge for volume responsiveness. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(5): 469-472. doi: 10.7507/1671-6205.201901057 Copy

1.	Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med, 2009, 37(9): 2642-3647.
2.	李文雯, 萬獻堯. 感染性休克時液體復蘇相關性肺損傷. 中國呼吸與危重監護雜志, 2012, 11(5): 510-513.
3.	Muller L, Toumi M, Bousquet PJ, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology, 2011, 115(3): 541-547.
4.	Wu Y, Zhou S, Zhou Z, et al. 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness. Crit Care, 2014, 18(3): R108.
5.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med, 2013, 39(2): 165-228.
6.	Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta analysis. Intensive Care Med, 2016, 42(12): 1935-1947.
7.	Lansdorp B, Lemson J, van Putten MJ, et al. Dynamic indices do not predict volume responsiveness in routine clinical practice. Br J Anaesth, 2012, 108(3): 395-401.
8.	Ganter MT, Geisen M, Hartnack S, et al. Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters. BMC Anesthesiol, 2018, 18(1): 55.
9.	申麗旻, 趙素琴, 趙鶴齡, 等. 《拯救膿毒癥運動: 2008 嚴重膿毒癥和膿毒癥休克管理指南》解讀(二): 液體復蘇和血管活性藥物的應用. 臨床薈萃, 2008, 23(8): 598-600.
10.	Sequeira V, van der Velden J. Historical perspective on heart function: the Frank-Starling Law. Biophys Rev, 2015, 7(4): 421-447.
11.	司向, 黃牧云, 陳娟, 等. 被動抬腿試驗對膿毒癥合并心功能不全患者液體反應性的預測價值. 中華危重病急救醫學, 2015, 27(9): 729-734.
12.	Mallat J, Meddour M, Lemyze M, et al. Effects of a rapid infusion of 20% human serum albumin solution on acid-base status and electrolytes in critically ill patients. Intensive Care Med, 2016, 42(1): 128-129.
13.	Guinot PG, Bernard E, Deleporte K, et al. Mini-fluid challenge can predict arterial pressure response to volume expansion in spontaneously breathing patients under spinal anaesthesia. Anaesth Crit Care Pain Med, 2015, 34(6): 333-337.
14.	Biais M, de Courson H, Lanchon R, et al. Mini-fluid challenge of 100 ml of crystalloid predicts fluid responsiveness in the operating room. Anesthesiology, 2017, 127(3): 450-456.
15.	杜微, 劉大為. Frank-Starling 曲線與容量管理. 中國實用內科雜志, 2015, 35(11): 887-896.

1. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med, 2009, 37(9): 2642-3647.
2. 李文雯, 萬獻堯. 感染性休克時液體復蘇相關性肺損傷. 中國呼吸與危重監護雜志, 2012, 11(5): 510-513.
3. Muller L, Toumi M, Bousquet PJ, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology, 2011, 115(3): 541-547.
4. Wu Y, Zhou S, Zhou Z, et al. 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness. Crit Care, 2014, 18(3): R108.
5. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med, 2013, 39(2): 165-228.
6. Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta analysis. Intensive Care Med, 2016, 42(12): 1935-1947.
7. Lansdorp B, Lemson J, van Putten MJ, et al. Dynamic indices do not predict volume responsiveness in routine clinical practice. Br J Anaesth, 2012, 108(3): 395-401.
8. Ganter MT, Geisen M, Hartnack S, et al. Prediction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters. BMC Anesthesiol, 2018, 18(1): 55.
9. 申麗旻, 趙素琴, 趙鶴齡, 等. 《拯救膿毒癥運動: 2008 嚴重膿毒癥和膿毒癥休克管理指南》解讀(二): 液體復蘇和血管活性藥物的應用. 臨床薈萃, 2008, 23(8): 598-600.
10. Sequeira V, van der Velden J. Historical perspective on heart function: the Frank-Starling Law. Biophys Rev, 2015, 7(4): 421-447.
11. 司向, 黃牧云, 陳娟, 等. 被動抬腿試驗對膿毒癥合并心功能不全患者液體反應性的預測價值. 中華危重病急救醫學, 2015, 27(9): 729-734.
12. Mallat J, Meddour M, Lemyze M, et al. Effects of a rapid infusion of 20% human serum albumin solution on acid-base status and electrolytes in critically ill patients. Intensive Care Med, 2016, 42(1): 128-129.
13. Guinot PG, Bernard E, Deleporte K, et al. Mini-fluid challenge can predict arterial pressure response to volume expansion in spontaneously breathing patients under spinal anaesthesia. Anaesth Crit Care Pain Med, 2015, 34(6): 333-337.
14. Biais M, de Courson H, Lanchon R, et al. Mini-fluid challenge of 100 ml of crystalloid predicts fluid responsiveness in the operating room. Anesthesiology, 2017, 127(3): 450-456.
15. 杜微, 劉大為. Frank-Starling 曲線與容量管理. 中國實用內科雜志, 2015, 35(11): 887-896.

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