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

Critical Care

AzuRea Group¹  Yazine Mahjoub²  Isabelle Desmeulles³  Jean-Michel Constantin⁴  Russell Chabanne⁴  Jean-Sébastien Faure⁴  Laurent Zieleskiewicz⁵  Karim Lakhal⁶  Hervé Quintard⁷  Laurent Muller⁸  Claire Roger⁸  Benjamin Louart⁸  Jean-Yves Lefrant⁸  Christophe Demattei⁹  Gael Piton^1,10 

[1] ;Department of Anesthesiology and Intensive Care Medicine, University Hospital of Amiens;Department of Anesthesiology and Intensive Care Medicine, University Hospital of Caen;Department of Anesthesiology and Intensive Care Medicine, University Hospital of Clermont-Ferrand;Department of Anesthesiology and Intensive Care Medicine, University Hospital of Marseille;Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nantes;Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nice;Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier;Department of Biostatistics Epidemiology and Medical information, Nîmes-Caremeau University Hospital, Univ Montpellier;Medical Intensive Care unit, University Hospital of Besançon;

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

DOI  :  10.1186/s13054-019-2448-z

来源: DOAJ

【 摘 要 】

Abstract Background Fluid 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. Methods This 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 (T 0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC. Results From 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 T 10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T 30 (49%, 95%CI = [37–60]), and 39 (51%, 95%CI = [38–62]) patients were persistent responders (PR), i.e., remained responders at T 30. Among the 67 NR at T 10, 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. Conclusions This 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 registration ClinicalTrials.gov, NCT02116413. Registered on April 16, 2014

【 授权许可】

Unknown