Assessing Fluid Responsiveness in Spontaneously Breathing Patients

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Joseph MillerBashar Nahab

Abstract

The primary objective of this study was to test if fasting volunteers exhibit fluid responsiveness using noninvasive hemodynamic measurements. The secondary objective was to test a passive leg raise (PLR) maneuver as a diagnostic predictor of fluid responsiveness. This was a quasi-experimental design involving healthy volunteers. Subjects were excluded for pregnancy and congestive heart failure. Following a 12-hour fast, subjects had baseline hemodynamic monitoring recorded using noninvasive, continuous pulse contour analysis. Subjects then had a PLR maneuver performed, followed by an intravenous bolus of crystalloid. A rise in stroke volume ≥ 10% from baseline with the bolus was considered consistent with fluid responsiveness, and the same rise with a PLR was consistent with a positive PLR maneuver. The primary outcome was the change in stroke volume with a fluid bolus. Univariate analysis assessed changes in hemodynamic parameters. Logistic regression analysis determined the test characteristics of the PLR in predicting subjects who were ultimately fluid responsive. Forty subjects completed the study. The mean change in stroke volume with a crystalloid bolus was 19% (95% confidence interval [CI] = 16% to 21%). Thirty-six (90%...Continue Reading

References

Jul 10, 2009·Critical Care : the Official Journal of the Critical Care Forum·Steven W ThielWarren Isakow
Jan 7, 2010·European Journal of Applied Physiology·Jasper TruijenJohannes J van Lieshout
Aug 2, 2011·The American Journal of Emergency Medicine·Richard M NowakMichele L Moyer
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Oct 16, 2012·Journal of Cardiothoracic and Vascular Anesthesia·Frederik TrinkmannJoachim Saur
Apr 30, 2015·Current Opinion in Critical Care·Koen AmelootManu L N G Malbrain

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