Hemodynamic responses of critically ill patients to intravenous fluid boluses

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Reference:

Lammi, M.R., Aiello, B., Burg, G.T., Rehman, T., Douglas, I.S., Wheeler, A.P. and deBoisblanc, B.P. (2015) Response to Fluid Boluses in the Fluid and Catheter Treatment Trial. Chest. May 28th. [epub ahead of print].

Abstract:

BACKGROUND: Recent emphasis has been placed on methods to predict fluid-responsiveness (FR), but the utility of using fluid boluses to increase cardiac index (CI) in critically-ill patients with ineffective circulation or oliguria remains unclear.

METHODS: Retrospective analysis investigating hemodynamic responses of critically ill patients in the ARDS Network Fluid and Catheter Treatment Trial (FACTT) who were given protocol-based fluid boluses. FR was defined as ≥15% increase in CI after a 15ml/kg fluid bolus.

RESULTS: A convenience sample of 127 critically-ill patients enrolled in FACTT was analyzed for physiologic responses to 569 protocolized crystalloid or albumin boluses given for shock, low urine output (UOP), or low pulmonary artery occlusion pressure (PAOP). There were significant increases in mean central venous pressure (9.9±4.5 to 11.1±4.8 mmHg, p<0.0001) and mean PAOP (11.6±3.6 to 13.3±4.3 mmHg, p<0.0001) following fluid boluses. However, there were no significant change in UOP, and clinically small changes in heart rate (HR), mean arterial pressure (MAP), and CI. Only 23% of fluid boluses led to a ≥15% change in CI. There was no significant difference in the frequency of fluid responsiveness between boluses given for shock or oliguria versus boluses given only for low PAOP (24.0% vs. 21.8%, p=0.59). There were no significant differences in 90-day survival, need for hemodialysis, or return to unassisted breathing between patients defined as fluid responders and fluid non-responders.

CONCLUSION: In this cohort of critically-ill and previously resuscitated ARDS patients, the rate of fluid responsiveness was low and fluid boluses only led to small hemodynamic changes.

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