Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milano, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.
Crit Care. 2022 Jun 21;26(1):186. doi: 10.1186/s13054-022-04056-3.
Fluid challenges are widely adopted in critically ill patients to reverse haemodynamic instability. We reviewed the literature to appraise fluid challenge characteristics in intensive care unit (ICU) patients receiving haemodynamic monitoring and considered two decades: 2000-2010 and 2011-2021.
We assessed research studies and collected data regarding study setting, patient population, fluid challenge characteristics, and monitoring. MEDLINE, Embase, and Cochrane search engines were used. A fluid challenge was defined as an infusion of a definite quantity of fluid (expressed as a volume in mL or ml/kg) in a fixed time (expressed in minutes), whose outcome was defined as a change in predefined haemodynamic variables above a predetermined threshold.
We included 124 studies, 32 (25.8%) published in 2000-2010 and 92 (74.2%) in 2011-2021, overall enrolling 6,086 patients, who presented sepsis/septic shock in 50.6% of cases. The fluid challenge usually consisted of 500 mL (76.6%) of crystalloids (56.6%) infused with a rate of 25 mL/min. Fluid responsiveness was usually defined by a cardiac output/index (CO/CI) increase ≥ 15% (70.9%). The infusion time was quicker (15 min vs 30 min), and crystalloids were more frequent in the 2011-2021 compared to the 2000-2010 period.
In the literature, fluid challenges are usually performed by infusing 500 mL of crystalloids bolus in less than 20 min. A positive fluid challenge response, reported in 52% of ICU patients, is generally defined by a CO/CI increase ≥ 15%. Compared to the 2000-2010 decade, in 2011-2021 the infusion time of the fluid challenge was shorter, and crystalloids were more frequently used.
在重症患者中，广泛采用液体挑战来逆转血流动力学不稳定。我们回顾了文献，评估了在接受血流动力学监测的 ICU 患者中进行液体挑战的特点，并考虑了两个二十年：2000-2010 年和 2011-2021 年。
我们评估了研究研究，并收集了有关研究设置、患者人群、液体挑战特征和监测的数据。使用了 MEDLINE、Embase 和 Cochrane 搜索引擎。液体挑战被定义为在固定时间（以分钟表示）内输注一定量的液体（以毫升或毫升/千克表示），其结果定义为预定阈值以上的预定血流动力学变量的变化。
我们纳入了 124 项研究，其中 32 项（25.8%）发表于 2000-2010 年，92 项（74.2%）发表于 2011-2021 年，总共纳入了 6086 名患者，其中 50.6%的患者患有脓毒症/脓毒性休克。液体挑战通常由 500ml（76.6%）晶体液（56.6%）组成，以 25ml/min 的速度输注。液体反应性通常通过心输出量/指数（CO/CI）增加≥15%（70.9%）来定义。输注时间更短（15 分钟与 30 分钟），并且在 2011-2021 年期间，与 2000-2010 年期间相比，晶体液更为频繁。
在文献中，液体挑战通常通过在不到 20 分钟内输注 500ml 晶体液来进行。在 52%的 ICU 患者中，报告的阳性液体挑战反应通常通过 CO/CI 增加≥15%来定义。与 2000-2010 十年相比，在 2011-2021 年期间，液体挑战的输注时间更短，晶体液的使用更为频繁。
