Supine transfer test-induced changes in cardiac index predict fluid responsiveness in patients without intra-abdominal hypertension

BMC Anesthesiology

Research

Qionghua Lin¹  Jing Liu¹  Yijun Zheng¹  Zhili Xia¹  Lihua Shen¹  Yaodong Zhang¹  Zhiyong Zhao¹  Danyan Gu¹  Fangfang Li¹  Biao Zhu¹  Qian Xing¹  Zhongwei Zhang¹  Shan Zhang¹  Pengmei Wang¹ 

[1] Department of Critical Care, Fudan University Shanghai Cancer Center, 200032, Shanghai, China;Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China;

关键词: Fluid responsiveness;    Supine transfer;    Cardiac index;    Intra-abdominal hypertension;   

DOI  :  10.1186/s12871-023-02280-0

 received in 2023-07-06, accepted in 2023-09-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe reversible maneuver that mimics the fluid challenge is a widely used test for evaluating volume responsiveness. However, passive leg raising (PLR) does have certain limitations. The aim of the study is to determine whether the supine transfer test could predict fluid responsiveness in adult patients with acute circulatory failure who do not have intra-abdominal hypertension, by measuring changes in cardiac index (CI).MethodsSingle-center, prospective clinical study in a 25-bed surgery intensive care unit at the Fudan University Shanghai Cancer Center. Thirty-four patients who presented with acute circulatory failure and were scheduled for fluid therapy. Every patient underwent supine transfer test and fluid challenge with 500 mL saline for 15–30 min. There were four sequential steps in the protocol: (1) baseline-1: a semi-recumbent position with the head of the bed raised to 45°; (2) supine transfer test: patients were transferred from the 45° semi-recumbent position to the strict supine position; (3) baseline-2: return to baseline-1 position; and (4) fluid challenge: administration of 500 mL saline for 15–30 min. Hemodynamic parameters were recorded at each step with arterial pulse contour analysis (ProAQT/Pulsioflex). A fluid responder was defined as an increase in CI ≥ 15% after fluid challenge. The receiver operating characteristic curve and gray zone were defined for CI.ResultsSeventeen patients were fluid challenge. The r value of the linear correlations was 0.73 between the supine transfer test- and fluid challenge-induced relative CI changes. The relative changes in CI induced by supine transfer in predicting fluid responsiveness had an area under the receiver operating characteristic curve of 0.88 (95% confidence interval 0.72–0.97) and predicted a fluid responder with 76.5% (95% confidence interval 50.1–93.2) sensitivity and 88.2% (95% confidence interval 63.6–98.5) specificity, at a best threshold of 5.5%. Nineteen (55%) patients were in the gray zone (CI ranging from -3 and 8 L/min/m2).ConclusionThe supine transfer test can potentially assist in detecting fluid responsiveness in patients with acute circulatory failure without intra-abdominal hypertension. Nevertheless, the small threshold and the 55% gray zone were noteworthy limitation.Trial registrationPredicting fluid responsiveness with supine transition test (ChiCTR2200058264). Registered 2022–04-04 and last refreshed on 2023–03-26, https://www.chictr.org.cn/showproj.html?proj=166175.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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