A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

Crit Care. 2014 May 27;18(3):R108. doi: 10.1186/cc13891.

Abstract

Introduction: The accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. Non-invasive evaluation of fluid responsiveness by the rapid infusion of a very limited amount of volume is an important clinical goal. This study aimed to test whether echocardiographic parameters could predict fluid responsiveness in critically ill patients following a low-volume (50-ml crystalloid solution) infusion over 10 seconds.

Methods: We prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10 seconds and a further 450 ml over 15 minutes. Cardiac output (CO), stroke volume (SV), aortic velocity time index (VTI), and left ventricular ejection fraction (LVEF) were recorded. Patients were classified as responders (Rs) if CO increased by at least 15% following the 500-ml volume expansion or were classified as non-responders (NRs) if CO increased by less than 15%. Area under the receiver operating characteristic curves (AUC) compared CO variations after 50 ml over 10 seconds (∆CO50) and 500 ml over 15 minutes (∆CO500) and the variation of VTI after infusion of 50 ml of fluid over 10 seconds (∆VTI50).

Results: In total, 50 patients were enrolled, and 27 (54%) of them were Rs. General characteristics, LVEF, heart rate, and central venous pressure were similar between Rs and NRs. In the Rs group, the AUC for ∆CO50 was 0.95 ± 0.03 (P <0.01; best cutoff value, 6%; sensitivity, 93%; specificity, 91%). Moreover, ∆CO50 and ∆CO500 were strongly correlated (r = 0.87; P <0.01). The AUC for ∆VTI50 was 0.91 ± 0.04 (P <0.01; best cutoff value, 9%; sensitivity, 74%; specificity, 95%). ∆VTI50 and ∆CO500 were positively correlated (r = 0.72; P <0.01).

Conclusion: In critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10 seconds (∆CO50 and ∆VTI50) can accurately predict fluid responsiveness.

Trial registration: Current Controlled Trials ISRCTN10524328. Registered 12 December 2013.

MeSH terms

  • Crystalloid Solutions
  • Echocardiography
  • Fluid Therapy*
  • Hemodynamics
  • Humans
  • Intensive Care Units
  • Isotonic Solutions / administration & dosage
  • Prospective Studies
  • Rehydration Solutions / administration & dosage
  • Sepsis / diagnostic imaging
  • Sepsis / physiopathology
  • Sepsis / therapy
  • Shock / diagnostic imaging*
  • Shock / physiopathology
  • Shock / therapy*
  • Shock, Septic / diagnostic imaging
  • Shock, Septic / physiopathology
  • Shock, Septic / therapy
  • Shock, Traumatic / diagnostic imaging
  • Shock, Traumatic / physiopathology
  • Shock, Traumatic / therapy

Substances

  • Crystalloid Solutions
  • Isotonic Solutions
  • Rehydration Solutions

Associated data

  • ISRCTN/ISRCTN10524328