Time course of fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study

Critical Care

Laurent Zieleskiewicz¹  Benjamin Louart²  Jean-Yves Lefrant²  Claire Roger²  Laurent Muller²  Christophe Demattei³  Hervé Quintard⁴  Isabelle Desmeulles⁵  Karim Lakhal⁶  Yazine Mahjoub⁷  Gael Piton⁸  Jean-Michel Constantin⁹  Russell Chabanne⁹  Jean-Sébastien Faure⁹ 

[1] 0000 0001 0407 1584, grid.414336.7, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Marseille, 13000, Marseille, France;Aix Marseille University, INSERM1263, INRA1260, C2VN, Marseille, France;0000 0001 2097 0141, grid.121334.6, Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France;0000 0001 2097 0141, grid.121334.6, Physiology Department. EA 2992, Faculty of Medicine, Univ Montpellier, Montpellier-Nimes University, Nîmes, France;0000 0001 2097 0141, grid.121334.6, Department of Biostatistics Epidemiology and Medical information, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France;0000 0001 2322 4179, grid.410528.a, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nice, 06000, Nice, France;0000 0004 0472 0160, grid.411149.8, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Caen, 14033, Caen, France;0000 0004 0472 0371, grid.277151.7, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nantes, 44000, Nantes, France;0000 0004 0593 702X, grid.134996.0, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Amiens, 80000, Amiens, France;0000 0004 0638 9213, grid.411158.8, Medical Intensive Care unit, University Hospital of Besançon, 25030, Besançon, France;0000 0004 0639 4151, grid.411163.0, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France;

关键词: Fluid responsiveness;    Fluid challenge;    ICU;    Shock;    Echocardiography;   

DOI  :  10.1186/s13054-019-2448-z

来源: publisher

【 摘 要 】

BackgroundFluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC.MethodsThis is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC.ResultsFrom May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43–63], median SOFA score 10 [8–12]). Among the 76/143 (53%) patient responders to FC at T10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T30 (49%, 95%CI = [37–60]), and 39 (51%, 95%CI = [38–62]) patients were persistent responders (PR), i.e., remained responders at T30. Among the 67 NR at T10, 4 became responders at T30, (6%, 95%CI = [1.9–15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups.ConclusionsThis study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent.Trial registrationClinicalTrials.gov, NCT02116413. Registered on April 16, 2014

【 授权许可】

CC BY