Newly Published
Perioperative Medicine  |   June 2017
Mini-fluid Challenge of 100 ml of Crystalloid Predicts Fluid Responsiveness in the Operating Room
Author Notes
  • From the Department of Anesthesiology and Critical Care III, Bordeaux University Hospital, Bordeaux, France (M.B., H.d.C., R.L., G.B., M.G., M.S., K.N.-G.); Institut National de la Santé et de la Recherche Médicale, U1034, Biology of Cardiovascular Diseases, Pessac, France (M.B.); University of Bordeaux, Bordeaux, France (M.B., K.N.-G.); Biostatistics Unit, Délégation Recherche Clinique & Innovation, CHU de Clermont-Ferrand, Clermont-Ferrand, France (B.P.); and Institut National de la Santé et de la Recherche Médicale, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme, Bordeaux, France (K.N.-G.).
  • Submitted for publication August 2, 2016. Accepted for publication February 23, 2017.
    Submitted for publication August 2, 2016. Accepted for publication February 23, 2017.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: Dr. Biais received honoraria from Edwards Lifesciences, Irvine, California, and Pulsion Medical System, Munich, Germany, for lectures. The other authors declare no competing interests.
    Competing Interests: Dr. Biais received honoraria from Edwards Lifesciences, Irvine, California, and Pulsion Medical System, Munich, Germany, for lectures. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Biais: Department of Anesthesiology and Critical Care III, Hôpital Pellegrin, CHU de Bordeaux, F-33076 Bordeaux Cedex, France. matthieu.biais@chu-bordeaux.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Critical Care / Neurosurgical Anesthesia / Renal and Urinary Systems / Electrolyte Balance / Respiratory System
Perioperative Medicine   |   June 2017
Mini-fluid Challenge of 100 ml of Crystalloid Predicts Fluid Responsiveness in the Operating Room
Anesthesiology Newly Published on June 22, 2017. doi:10.1097/ALN.0000000000001753
Anesthesiology Newly Published on June 22, 2017. doi:10.1097/ALN.0000000000001753
Abstract

Background: Mini-fluid challenge of 100 ml colloids is thought to predict the effects of larger amounts of fluid (500 ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100 ml) could predict the effects of 250 ml crystalloid in mechanically ventilated patients in the operating room.

Methods: A total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250 ml saline 0.9%) was given to maximize cardiac output during surgery. Stroke volume index (monitored using pulse contour analysis) and pulse pressure variations were recorded before and after 50 ml infusion (given for 1 min), after another 50 ml infusion (given for 1 min), and finally after 150 ml infusion (total = 250 ml). Changes in stroke volume index induced by 50, 100, and 250 ml were recorded. Positive fluid challenges were defined as an increase in stroke volume index of 10% or more from baseline after 250 ml.

Results: A total of 88 fluid challenges were performed (32% of positive fluid challenges). Changes in stroke volume index induced by 100 ml greater than 6% (gray zone between 4 and 7%, including 19% of patients) predicted fluid responsiveness with a sensitivity of 93% (95% CI, 77 to 99%) and a specificity of 85% (95% CI, 73 to 93%). The area under the receiver operating curve of changes in stroke volume index induced by 100 ml was 0.95 (95% CI, 0.90 to 0.99) and was higher than those of changes in stroke volume index induced by 50 ml (0.83 [95% CI, 0.75 to 0.92]; P = 0.01) and pulse pressure variations (0.65 [95% CI, 0.53 to 0.78]; P < 0.005).

Conclusions: Changes in stroke volume index induced by rapid infusion of 100 ml crystalloid predicted the effects of 250 ml crystalloid in patients ventilated mechanically in the operating room.