Does the Response to a Mini-fluid Challenge of 3ml/kg in 2 Minutes Predict Fluid Responsiveness for Pediatric Patient?
Condition: Anesthesia
Study type: Interventional

Summary: 
      To predict fluid responsiveness in anesthetized pediatric patient is not an easy task
      although anesthesia provider has to deal with this question on their daily practices. Today,
      very few parameters can help anesthesia provider to predict fluid responsiveness in the
      pediatric anesthetized patient. Therefore anesthesia provider are let with fluid challenge
      with high volume of fluid boluses to see if patient were fluid responsive or not. This could
      lead to fluid overload and it's associated morbidity. We would like to investigate if the
      cardiac output response to a mini fluid challenge of 3 ml/kg in 2 minutes would be predictive
      of the response to an usual fluid challenge of 15 ml/kg in 10 minutes in elective pediatric
      anesthetized patients.
    

Detailed description: 
      The main objective is to determine whether the new test "the stroke volume variation after
      fluid challenge of 3ml/Kg" provides information about fluid responsiveness namely increased
      cardiac output. This new test will be compared to "gold standard" that is, "the stroke volume
      variation after standard fluid challenge of 15ml/Kg". It is the evaluation of the diagnostic
      accuracy of a diagnostic test based on an index obtained by transthoracic cardiac
      echocardiography for diagnosing fluid responsiveness. This index is the stroke volume
      variation measured by transthoracic cardiac echography.

      The study will include anesthetized patients undergoing scheduled surgery. For hemodynamic
      optimization, these patients will benefit, early after anaesthetic induction, before the
      surgical procedure has started, from a fluid challenge of 15ml/kg achieved in two stages (3
      ml/Kg then 12 ml/kg) separated by an interval of one minute. Three-time hemodynamic will be
      analyzed.

        -  T0: basal

        -  T1: one minute after first vascular filling with 3ml/Kg in 2 minutes

        -  T2: one minute after second vascular filling with 12 ml/Kg in 8 minutes which is
           performed one minute after the end of the first filling (a total of 15 ml/kg)

      At each time, we will retrieve a collection of hemodynamic data (stroke volume, cardiac
      output) obtained by transthoracic echocardiography, standard method to assess fluid
      responsiveness. And at the same times, the PVI and hemodynamic parameters obtained by
      esophageal Doppler will be noted.
    

Intervention name(s): fluid challenge
Intervention type(s): Drug
Intervention description(s): fluid challenge realized after induction of anesthesia at a steady state, to assess fluid responsiveness and correct hypovolemia. The usual fluid bolus of 15ml/kg in 10 minute will be fragmented in 2 fluid boluses (3ml/kg in 2 minutes followed by measurement of hemodynamic parameter after 1 minute of the end of the 1st fluid bolus and followed by 12 ml/kg in 8 minutes then followed by measurement of hemodynamic parameters after one minute after the end of the 2nd fluid fragmented fluid challenge. Total administered: 15 ml/kg in 11 minutes. end of the study at 12 minutes.
Other intervention name(s): fluid bolus
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: pediatric; anesthesia; fluid responsiveness; hemodynamic