Poster presentation
Open Access
Volume 19 Supplement 2
Eighth International Symposium on Intensive Care and Emergency Medicine for Latin America
Assessment of fluid responsiveness in spontaneously breathing critically ill patients
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 |
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
- 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
- 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
- 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
- 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.
