Prediction of fluid responsiveness in patients admitted to the medical intensive care unit
Standard
Prediction of fluid responsiveness in patients admitted to the medical intensive care unit. / Saugel, Bernd; Kirsche, Stephanie V; Hapfelmeier, Alexander; Phillip, Veit; Schultheiss, Caroline; Schmid, Roland M; Huber, Wolfgang.
in: J CRIT CARE, Jahrgang 28, Nr. 4, 01.08.2013, S. 537.e1-9.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Prediction of fluid responsiveness in patients admitted to the medical intensive care unit
AU - Saugel, Bernd
AU - Kirsche, Stephanie V
AU - Hapfelmeier, Alexander
AU - Phillip, Veit
AU - Schultheiss, Caroline
AU - Schmid, Roland M
AU - Huber, Wolfgang
N1 - Copyright © 2013 Elsevier Inc. All rights reserved.
PY - 2013/8/1
Y1 - 2013/8/1
N2 - PURPOSE: Accurate prediction of fluid responsiveness is of importance in the treatment of patients admitted to the intensive care unit (ICU). We investigated whether physical examination, central venous pressure (CVP), central venous oxygen saturation (ScvO2), passive leg raising (PLR) test, and transpulmonary thermodilution (TPTD)-derived parameters can predict volume responsiveness in patients admitted to the ICU.MATERIALS AND METHODS: In this prospective study, structured clinical examination, measurement of CVP and ScvO2, a PLR test, and TPTD measurements were performed in 31 patients. A fluid challenge test was performed in 24 patients (fluid responsiveness was defined as a cardiac index [CI] increase of ≥ 15%).RESULTS: Physical examination, CVP, ScvO2, the PLR test, and the TPTD-derived volumetric preload parameter global end-diastolic volume index showed poor prognostic capabilities regarding prediction of fluid responsiveness. Twenty-nine percent of patients were fluid responsive. There was a statistically significant correlation between the fluid challenge-induced increase in CI and changes in global end-diastolic volume index (r = 0.666, P < .001). In only 17% of patients, CI did not increase after fluid loading.CONCLUSIONS: Prediction of fluid responsiveness is difficult using physical examination, CVP, ScvO2, PLR maneuver, or TPTD-derived variables in critically ill patients. A volume challenge test should be considered for the assessment of fluid responsiveness in critically ill patients admitted to the ICU.
AB - PURPOSE: Accurate prediction of fluid responsiveness is of importance in the treatment of patients admitted to the intensive care unit (ICU). We investigated whether physical examination, central venous pressure (CVP), central venous oxygen saturation (ScvO2), passive leg raising (PLR) test, and transpulmonary thermodilution (TPTD)-derived parameters can predict volume responsiveness in patients admitted to the ICU.MATERIALS AND METHODS: In this prospective study, structured clinical examination, measurement of CVP and ScvO2, a PLR test, and TPTD measurements were performed in 31 patients. A fluid challenge test was performed in 24 patients (fluid responsiveness was defined as a cardiac index [CI] increase of ≥ 15%).RESULTS: Physical examination, CVP, ScvO2, the PLR test, and the TPTD-derived volumetric preload parameter global end-diastolic volume index showed poor prognostic capabilities regarding prediction of fluid responsiveness. Twenty-nine percent of patients were fluid responsive. There was a statistically significant correlation between the fluid challenge-induced increase in CI and changes in global end-diastolic volume index (r = 0.666, P < .001). In only 17% of patients, CI did not increase after fluid loading.CONCLUSIONS: Prediction of fluid responsiveness is difficult using physical examination, CVP, ScvO2, PLR maneuver, or TPTD-derived variables in critically ill patients. A volume challenge test should be considered for the assessment of fluid responsiveness in critically ill patients admitted to the ICU.
KW - Aged
KW - Central Venous Pressure
KW - Critical Illness
KW - Female
KW - Fluid Therapy
KW - Hemodynamics
KW - Humans
KW - Intensive Care
KW - Intensive Care Units
KW - Leg
KW - Male
KW - Middle Aged
KW - Oxygen
KW - Physical Examination
KW - Predictive Value of Tests
KW - Prognosis
KW - Prospective Studies
KW - Statistics, Nonparametric
KW - Thermodilution
U2 - 10.1016/j.jcrc.2012.10.008
DO - 10.1016/j.jcrc.2012.10.008
M3 - SCORING: Journal article
C2 - 23142517
VL - 28
SP - 537.e1-9
JO - J CRIT CARE
JF - J CRIT CARE
SN - 0883-9441
IS - 4
ER -