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Annals of Intensive Care

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Open Access 01-12-2019 | Shock | Research

How to detect a positive response to a fluid bolus when cardiac output is not measured?

Authors: Zakaria Ait-Hamou, Jean-Louis Teboul, Nadia Anguel, Xavier Monnet

Published in: Annals of Intensive Care | Issue 1/2019

Abstract

Background

Volume expansion is aimed at increasing cardiac output (CO), but this variable is not always directly measured. We assessed the ability of changes in arterial pressure, pulse pressure variation (PPV) and heart rate (HR) or of a combination of them to detect a positive response of cardiac output (CO) to fluid administration.

Methods

We retrospectively included 491 patients with circulatory failure. Before and after a 500-mL normal saline infusion, we measured CO (PiCCO device), HR, systolic (SAP), diastolic (DAP), mean (MAP) and pulse (PP) arterial pressure, PPV, shock index (HR/SAP) and the PP/HR ratio.

Results

The fluid-induced changes in HR were not correlated with the fluid-induced changes in CO. The area under the receiver operating characteristic curve (AUROC) for changes in HR as detectors of a positive fluid response (CO increase ≥ 15%) was not different from 0.5. The fluid-induced changes in SAP, MAP, PP, PPV, shock index (HR/SAP) and the PP/HR ratio were correlated with the fluid-induced changes in CO, but with r < 0.4. The best detection was provided by increases in PP, but it was rough (AUROC = 0.719 ± 0.023, best threshold: increase ≥ 10%, sensitivity = 72 [66–77]%, specificity = 64 [57–70]%). Neither the decrease in shock index nor the changes in other indices combining changes in HR, shock index, PPV and PP provided a better detection of a positive fluid response than changes in PP.

Conclusion

A positive response to fluid was roughly detected by changes in PP and not detected by changes in HR. Changes in combined indices including the shock index and the PP/HR ratio did not provide a better diagnostic accuracy.

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Title: How to detect a positive response to a fluid bolus when cardiac output is not measured?
Authors: Zakaria Ait-Hamou
Jean-Louis Teboul
Nadia Anguel
Xavier Monnet
Publication date: 01-12-2019
Publisher: Springer International Publishing
Keywords: Shock
Shock
Published in: Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-019-0612-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How to detect a positive response to a fluid bolus when cardiac output is not measured?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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