Timing Assessment of Response to Fluid Challenge in Patients with Septic Shock

Objectives: Fluid challenge (FC) is most commonly used for fluid responsiveness (FR) evaluation, with a wide divergence in assessment time choices. Therefore, we aimed to explore the optimal assessment time for FC in patients with septic shock. Methods: A prospective cohort study was conducted. Septic shock patients who had experienced initial resuscitation and required an FC with 500 mL 4% gelatin or normal saline (NS) over 5-10 min were included. FR was defined by an increase in cardiac index (CI) >10%. FR and other predefined variables were recorded at baseline (Tb), immediately (T0), and at 10 (T1), 30 (T2), 45 (T3), 60 (T4), 90 (T5), and 120 (T6) min after FC. The incidence of FR and hemodynamic variables at predefined time points were recorded. Data were analyzed by repeated measures of analysis of variance. Results: 63 patients were enrolled, with 43 in the gelatin group and 20 in the NS group. Among the 45/63 (71%) responders, 31 were responded at T0 (ER), while 14 responded at T1 or later (LR). The proportion of NR, ER and LR was comparable between gelatin and NS groups. After FC, the time course of FR status was slightly different between gelatin and NS groups. In the gelatin group, FC induced most responders (69%, 31/45) and frequency of CI maximum (35%, 11/31) at T2 and sustained a positive FR status until T4; while in the NS group, FC induced most responders (55%, 11/20) and frequency of CI maximum (64%, 9/14) at T1, and sustained FR status until T1. Conclusions: Different time courses of FR were found between gelatin and NS group patients undergoing FC. Thus, when NS is used, FR should be performed within 10 min, while it is better to extend the assessment time to 30 min after FC when gelatin is used.

[1]  J. Constantin,et al.  Time course of fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study , 2019, Critical Care.

[2]  P. Navalesi,et al.  Use of the Fluid Challenge in Critically Ill Adult Patients: A Systematic Review , 2017, Anesthesia and analgesia.

[3]  H. Ueyama,et al.  Predicting the Need for Fluid Therapy—Does Fluid Responsiveness Work? , 2017, Journal of Intensive Care.

[4]  Sangeeta Mehta,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 , 2017, Intensive Care Medicine.

[5]  M. Cecconi,et al.  Pharmacodynamic Analysis of a Fluid Challenge , 2016, Critical care medicine.

[6]  M. Cecconi,et al.  Fluid challenges in intensive care: the FENICE study , 2015, Intensive Care Medicine.

[7]  J. Hanouz,et al.  Cephalic versus digital plethysmographic variability index measurement: a comparative pilot study in cardiac surgery patients. , 2014, Journal of cardiothoracic and vascular anesthesia.

[8]  F. Machado,et al.  Duration of hemodynamic effects of crystalloids in patients with circulatory shock after initial resuscitation , 2014, Annals of Intensive Care.

[9]  J. Hanouz,et al.  Prediction of responsiveness to an intravenous fluid challenge in patients after cardiac surgery with cardiopulmonary bypass: a comparison between arterial pulse pressure variation and digital plethysmographic variability index. , 2013, Journal of cardiothoracic and vascular anesthesia.

[10]  J. Hanouz,et al.  Assessment of changes in cardiac index and fluid responsiveness: a comparison of Nexfin and transpulmonary thermodilution , 2013, Acta anaesthesiologica Scandinavica.

[11]  J. Hanouz,et al.  Cerebral and somatic near-infrared spectroscopy measurements during fluid challenge in cardiac surgery patients: a descriptive pilot study. , 2013, Journal of cardiothoracic and vascular anesthesia.

[12]  J. Hanouz,et al.  Can endotracheal bioimpedance cardiography assess hemodynamic response to passive leg raising following cardiac surgery? , 2012, Annals of Intensive Care.

[13]  Xavier Monnet,et al.  Hemodynamic parameters to guide fluid therapy , 2011, Annals of intensive care.

[14]  K. Walley,et al.  Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality* , 2011 .

[15]  Attila Havas,et al.  Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients , 2010, European journal of anaesthesiology.

[16]  J. Twisk,et al.  Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia , 2010, Intensive Care Medicine.

[17]  H. Christiaans,et al.  Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery , 2006, Intensive Care Medicine.

[18]  K. Calman,et al.  INCREASED VASCULAR PERMEABILITY: A MAJOR CAUSE OF HYPOALBUMINAEMIA IN DISEASE AND INJURY , 1985, The Lancet.

[19]  C. Rothe,et al.  Reflex control of veins and vascular capacitance. , 1983, Physiological reviews.

[20]  S. Taback,et al.  Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. , 2010, The Cochrane database of systematic reviews.

[21]  D. Bereczki,et al.  The Cochrane Database of Systematic Reviews , 2003 .

[22]  J. Teboul,et al.  Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. , 2002, Chest.