Volume 19 Supplement 2

Eighth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Assessment of fluid responsiveness in spontaneously breathing critically ill patients

  • Renato CF Chaves1 and
  • Murillo SC Assunção2
Critical Care201519(Suppl 2):P39

https://doi.org/10.1186/cc14688

Published: 28 September 2015

Introduction

One of the main challenges in critical patient management is to assess the blood volume and determine which patients will benefit from volume expansion and which patients will benefit from support with vasopressor and/or inotropic drugs. It is known that 40-72 % of critical patients respond to volume expansion with increased stroke volume or cardiac index.

Objective

To search the literature for methods assessing fluid responsiveness in spontaneously breathing critically ill patients.

Methods

The present study is a systematic literature review. We searched randomized clinical trials through a blind search performed by two independent authors in any language in the National Library of Medicine from 2009 to 2014.

Results

We selected three articles for full review and analysis, totaling 116 patients. The results are shown in Table 1.
Table 1

Accuracy of hemodynamic parameters for predicting fluid responsiveness.

 

Préau et al., 2010 [4](n= 34)

Préau et al., 2012[2](n= 23)

Hong et al., 2014 [3](n= 59)

Parameter

ΔSV-PLR

ΔPP-PLR

ΔVF-PLR

ΔPP

ΔPP-dim

ΔVF

ΔVF-dim

ΔPP-TB

ΔPP-FB

Threshold value (%)

10

9

8

10

12

10

12

NS

13.7

Sensitivity (%)

86

79

86

60

90

60

90

NS

89.7

Specificity (%)

90

85

80

100

100

100

100

NS

86.7

ROC curve area

0.94

0.86

0.93

0.71

0.95

0.74

0.95

0.618

0.910

p value

<0.001

<0.01

<0.001

0.02

<0.01

0.02

<0.01

0.112

<0.0001

Responders

14

14

14

10

10

10

10

29

29

Dim deep inspiration maneuver-induced change, FB forced inspiratory breathing, NS non specified, PLR passive leg raising induced change, ΔPP pulse pressure, ΔSV stroke volume, TB tidal breathing, ΔVF peak velocity of femoral artery flow

Conclusion

This systematic review supports the beneficial effects of adopting maneuvers that amplify the hemodynamic changes, increasing the accuracy of methods to predict fluid responsiveness in spontaneously breathing critically ill patients.

Authors’ Affiliations

(1)
Department of Intensive Care Medicine, Hospital Santa Lúcia
(2)
Department of Intensive Care Medicine, Hospital Israelita Albert Einstein

References

  1. Dong ZZ, Fang Q, Zheng X, Shi H: Passive leg raising as an indicator of fluid responsiveness in patients with severe sepsis. World J Emerg Med. 2012, 3: 191-6. 10.5847/wjem.j.issn.1920-8642.2012.03.006.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Préau S, Dewavrin F, Soland V, Bortolotti P, Colling D, Chagnon JL, Durocher A, Saulnier F: Hemodynamic changes during a deep inspiration maneuver predict fluid responsiveness in spontaneously breathing patients. Cardiol Res Pract. 2012, 2012: 191807-PubMed CentralPubMedGoogle Scholar
  3. Hong DM, Lee JM, Seo JH, Min JJ, Jeon Y, Bahk JH: Pulse pressure variation to predict fluid responsiveness in spontaneously breathing patients: tidal vs. forced inspiratory breathing. Anaesthesia. 2014, 69: 717-22. 10.1111/anae.12678.View ArticlePubMedGoogle Scholar
  4. Préau S, Saulnier F, F Dewavrin, Durocher A, Chagnon JL: Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis. Critical Care Medicine. 2010, 38 (3): 819-825. 10.1097/CCM.0b013e3181c8fe7a.View ArticlePubMedGoogle Scholar

Copyright

© Chaves et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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