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.
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 illpatients. A volume challenge test should be considered for the assessment of fluid responsiveness in critically illpatients admitted to the ICU.
Authors: Azriel Perel; Bernd Saugel; Jean-Louis Teboul; Manu L N G Malbrain; Francisco Javier Belda; Enrique Fernández-Mondéjar; Mikhail Kirov; Julia Wendon; Roger Lussmann; Marco Maggiorini Journal: J Clin Monit Comput Date: 2015-12-10 Impact factor: 2.502
Authors: Bernd Saugel; Moritz Wildgruber; Albrecht Staudt; Michael Dieckmeyer; Konstantin Holzapfel; Georgios Kaissis; Mikhail Y Kirov; Vsevolod V Kuzkov; Roland M Schmid; Wolfgang Huber Journal: J Clin Monit Comput Date: 2018-04-21 Impact factor: 2.502
Authors: B Saugel; P C Reese; J Y Wagner; M Buerke; W Huber; S Kluge; R Prondzinsky Journal: Med Klin Intensivmed Notfmed Date: 2017-05-04 Impact factor: 0.840
Authors: Bernd Saugel; Wolfgang Huber; Axel Nierhaus; Stefan Kluge; Daniel A Reuter; Julia Y Wagner Journal: Biomed Res Int Date: 2016-09-14 Impact factor: 3.411