A mini-fluid challenge of 150 mL predicts fluid responsiveness using Modelflow R pulse contour cardiac output directly after cardiac surgery

• Published in: Journal of clinical anesthesia 2018-05, Vol.46, p.17
• Main Authors: Smorenberg, Annemieke, Cherpanath, Thomas GV, Geerts, Bart F, Robert BP de Wilde, Jansen, Jos RC, Maas, Jacinta J, Groeneveld, AB Johan
• Format: Article
• Language: English
• Subjects: Catheters; Heart surgery; Intensive care; Patients; Pulmonary arteries; Veins & arteries
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2017.12.022

Study objectiveThe mini-fluid challenge may predict fluid responsiveness with minimum risk of fluid overloading. However, the amount of fluid as well as the best manner to evaluate the effect is unclear. In this prospective observational pilot study, the value of changes in pulse contour cardiac output (CO) measurements during mini-fluid challenges is investigated.DesignProspective observational study.SettingIntensive Care Unit of a university hospital.PatientsTwenty-one patients directly after elective cardiac surgery on mechanical ventilation.InterventionsThe patients were subsequently given 10 intravenous boluses of 50mL of hydroxyethyl starch with a total of 500mL per patient while measuring pulse contour CO.MeasurementsWe measured CO by minimal invasive ModelflowR (COm) and PulseCOR (COli), before and one minute after each fluid bolus. We analyzed the smallest volume that was predictive of fluid responsiveness. A positive fluid response was defined as an increase in CO of >10% after 500mL fluid infusion.Main resultsFifteen patients (71%) were COm responders and 13 patients (62%) COli responders. An increase in COm after 150mL of fluid >5.0% yielded a positive and negative predictive value (+PV and −PV) of 100% with an area under the curve (AUC) of 1.00 (P6.3% after 200mL was able to predict a fluid response in COli after 500mL with a +PV of 100% and −PV of 73%, with an AUC of 0.88 (P