Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Univ Montpellier, Place du Professeur Robert Debré, 30 029, Nîmes Cedex 9, France.
Physiology Department. EA 2992, Faculty of Medicine, Univ Montpellier, Montpellier-Nimes University, Nîmes, France.
Crit Care. 2019 May 16;23(1):179. doi: 10.1186/s13054-019-2448-z.
Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC.
This is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T), at the end of FC (T), then 10 (T) and 20 min (T) after the end of FC.
From May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43-63], median SOFA score 10 [8-12]). Among the 76/143 (53%) patient responders to FC at T, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T (49%, 95%CI = [37-60]), and 39 (51%, 95%CI = [38-62]) patients were persistent responders (PR), i.e., remained responders at T. Among the 67 NR at T, 4 became responders at T30, (6%, 95%CI = [1.9-15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups.
This study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent.
ClinicalTrials.gov , NCT02116413 . Registered on April 16, 2014.
在重症监护病房（ICU）中，液体冲击（FC）是最常见的操作之一。本研究旨在评估在输液结束时或 20 分钟后对 FC 反应的超声心动图评估是否会影响 FC 的结果。
这是一项前瞻性、观察性、多中心研究，包括所有需要在 10 分钟内输注 500ml 晶体液的败血症性休克 ICU 患者。液体反应性定义为通过速度时间积分（VTI）测量在基线（T）、FC 结束时（T）、FC 结束后 10 分钟（T）和 20 分钟（T）时 SV 增加>15%。
从 2014 年 5 月 20 日至 2016 年 1 月 7 日，共有 143 例患者在 11 个法国 ICU 中接受了研究（平均年龄 64±14 岁，IGS II 中位数为 53[43-63]，SOFA 评分中位数为 10[8-12]）。在 T 时对 FC 有反应的 143 例患者中，有 76 例（53%）为一过性反应者（TR），即在 T 时变为无反应者（NR）（49%，95%CI=37-60%），39 例（51%）为持续性反应者（PR），即在 T 时仍为反应者。在 T 时的 67 例 NR 中，有 4 例在 T30 时成为反应者（6%，95%CI=1.9-15.3%）。在亚组分析中，各组之间的血流动力学和超声心动图参数无统计学差异。
本研究表明，51.3%的初始反应者在液体输注开始后 30 分钟仍有持续反应，仅有 41.3%的初始反应者有一过性反应，这表明液体反应性是时间依赖性的。
ClinicalTrials.gov，NCT02116413。于 2014 年 4 月 16 日注册。
