title: An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study.
abstract: BACKGROUND
  Predicting fluid responsiveness remains a difficult question in hemodynamically unstable patients. The author's objective was to test whether noninvasive assessment by transthoracic echocardiography of subaortic velocity time index (VTI) variation after a low volume of fluid infusion (100 ml hydroxyethyl starch) can predict fluid responsiveness.
  
  
  METHODS
  Thirty-nine critically ill ventilated and sedated patients with acute circulatory failure were prospectively studied. Subaortic VTI was measured by transthoracic echocardiography before fluid infusion (baseline), after 100 ml hydroxyethyl starch infusion over 1 min, and after an additional infusion of 400 ml hydroxyethyl starch over 14 min. The authors measured the variation of VTI after 100 ml fluid (ΔVTI 100) for each patient. Receiver operating characteristic curves were generated for (ΔVTI 100). When available, receiver operating characteristic curves also were generated for pulse pressure variation and central venous pressure.
  
  
  RESULTS
  After 500 ml volume expansion, VTI increased ≥ 15% in 21 patients (54%) defined as responders. ΔVTI 100 ≥ 10% predicted fluid responsiveness with a sensitivity and specificity of 95% and 78%, respectively. The area under the receiver operating characteristic curves of ΔVTI 100 was 0.92 (95% CI: 0.78-0.98). In 29 patients, pulse pressure variation and central venous pressure also were available. In this subgroup of patients, the area under the receiver operating characteristic curves for ΔVTI 100, pulse pressure variation, and central venous pressure were 0.90 (95% CI: 0.74-0.98, P < 0.05), 0.55 (95% CI: 0.35-0.73, NS), and 0.61 (95% CI: 0.41-0.79, NS), respectively.
  
  
  CONCLUSIONS
  In patients with low volume mechanical ventilation and acute circulatory failure, ΔVTI 100 accurately predicts fluid responsiveness.
authors.affiliation: Division Anesthésie Réanimation Urgences Douleur, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, Nîmes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
authors.forename: Medhi
authors.initials: M
authors.lastname: Toumi
authors.forename: Philippe-Jean
authors.initials: PJ
authors.lastname: Bousquet
authors.forename: Béatrice
authors.initials: B
authors.lastname: Riu-Poulenc
authors.forename: Guillaume
authors.initials: G
authors.lastname: Louart
authors.forename: Damien
authors.initials: D
authors.lastname: Candela
authors.forename: Lana
authors.initials: L
authors.lastname: Zoric
authors.forename: Carey
authors.initials: C
authors.lastname: Suehs
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
mesh_terms: D000368:Aged; D000465:Algorithms; D001011:Aorta / Q000502:physiology; D019540:Area Under Curve; D001772:Blood Cell Count; D001783:Blood Flow Velocity; D003326:Coronary Circulation / Q000502:physiology*; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012121:Respiration, Artificial; D013318:Stroke Volume / Q000502:physiology
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes