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Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients

BACKGROUND: It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arteria...

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Autores principales: Yang, Ting, Weng, Li, Jiang, Wei, Li, Shan, Du, Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276377/
https://www.ncbi.nlm.nih.gov/pubmed/34935687
http://dx.doi.org/10.1097/CM9.0000000000001919
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author Yang, Ting
Weng, Li
Jiang, Wei
Li, Shan
Du, Bin
author_facet Yang, Ting
Weng, Li
Jiang, Wei
Li, Shan
Du, Bin
author_sort Yang, Ting
collection PubMed
description BACKGROUND: It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed. METHODS: Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion. RESULTS: Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84–1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46–2.78) mmHg/mL to 1.83 (1.34–2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59–0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33–0.67, P = 0.086). CONCLUSION: In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04515511
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spelling pubmed-92763772022-07-13 Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients Yang, Ting Weng, Li Jiang, Wei Li, Shan Du, Bin Chin Med J (Engl) Original Articles BACKGROUND: It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed. METHODS: Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion. RESULTS: Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84–1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46–2.78) mmHg/mL to 1.83 (1.34–2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59–0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33–0.67, P = 0.086). CONCLUSION: In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04515511 Lippincott Williams & Wilkins 2022-03-20 2021-12-22 /pmc/articles/PMC9276377/ /pubmed/34935687 http://dx.doi.org/10.1097/CM9.0000000000001919 Text en Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Articles
Yang, Ting
Weng, Li
Jiang, Wei
Li, Shan
Du, Bin
Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
title Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
title_full Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
title_fullStr Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
title_full_unstemmed Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
title_short Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
title_sort hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276377/
https://www.ncbi.nlm.nih.gov/pubmed/34935687
http://dx.doi.org/10.1097/CM9.0000000000001919
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