Small Volume Fluid Challenge as a Predictor of Fluid Responsiveness in Patients With Circulatory Failure
Condition: Circulatory Failure
MeSH terms: Shock
Study type: Observational

Summary: 
      Assessment of intravascular volume status is difficult in critically ill patients. Evidence
      suggests that only 50% of hemodynamically unstable patients respond to a fluid challenge.
      Moreover, if cardiopulmonary function cannot compensate for the increase in preload, fluid
      loading may compromise microvascular perfusion and oxygen delivery and cause or aggravate
      peripheral and pulmonary edema. Inappropriate fluid expansion can increase morbidity and
      mortality thus making it important to accurately assess fluid responsiveness in critically
      ill patients. The volume responsiveness can be defined as a 15% increase in stroke volume
      (SV) or cardiac output (CO) after a 500-ml infusion. This study tested whether
      echocardiographic parameters can predict fluid responsiveness in critically ill patients
      following a low volume 100-ml crystalloid solution infusion over 1 minute.
    

Detailed description: 
      Fifty-four adult patients with circulatory failure were recruited for the study. As a routine
      work in adult critical care unit at Menoufia University hospital for patients with
      circulatory failure, a 100 ml bolus of normal saline solution was given to the patient over 1
      minute through a central venous catheter or jugular cannula. For prediction of responders,
      echocardiographic parameters were recorded1 minute after bolus administration. The remaining
      400 ml of normal saline solution was infused at a constant rate over 10 minutes, and
      echocardiographic parameters were recorded again. The mean echocardiographic measurements
      over three consecutive respiratory cycles were recorded along with heart rate HR, systolic,
      diastolic and mean arterial pressures, central venous pressure, and Temperature also
      mechanical ventilation parameter (tidal volume, respiratory rate and PEEP) for each patient.
      Patients with an increase in CO after a 100 ml or total 500-ml infusion over 10 minutes
      (ΔCO500) of 15% or more were classified as responders (Rs) and those without an increase in
      CO was classified as non-responders
    

Intervention name(s): Normal Saline Flush, 0.9% Injectable Solution
Intervention type(s): Drug
Intervention description(s): As a routine work in adult critical care unit at Menoufia University hospital for patients with circulatory failure, A 100 ml bolus of Normal Saline Flush, 0.9% Injectable Solution was given to the patient over 1 minute through a central venous catheter or jugular cannula. For prediction of responders, echocardiographic parameters measured followed by infusion of the remaining 400 ml of Normal Saline Flush, 0.9% Injectable Solution at a constant rate over 10 minutes then echocardiographic parameters measured again to detect the patient response.
Other intervention name(s): normal saline
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        in a general adult critical care unit (CCU) at Menoufia University Hospitals