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Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia?
Paediatr Anaesth. 2020 02; 30(2):161-167.PA

Abstract

BACKGROUND

Very little evidence for predictive markers of fluid responsiveness has been reported in children as compared to adults. The impact of hypovolemia or hypervolemia on morbidity has driven interest in the fluid challenge titration strategy.

AIM

The objective of this study was to explore the ability of a 3 mL kg-1 mini-fluid challenge over 2 minutes to predict fluid responsiveness in children under controlled ventilation.

METHODS

Children scheduled for surgery under general anesthesia were included and received a fluid challenge of 15 mL kg-1 of crystalloid prior to incision administered over 10 minutes in two steps: 3 mL kg-1 over 2 minutes then 12 mL kg-1 over 8 minutes. Fluid responsiveness was defined as a change of ≥10% in cardiac output estimated by left ventricular outflow tract velocity time integral (VTI) as measured by transthoracic ultrasound before and after the fluid challenge of 15 mL kg-1 .

RESULTS

Of the 55 patients included in the analysis, 43 were fluid responders. The increase in the VTI after the mini-fluid challenge (ΔVTIminiFC) predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.77; 95% CI (0.63-0.87), P = .004. Considering the least significant change which was 7.9%; 95% CI (6-10), the threshold was 8% with a sensitivity of 53%; 95% CI (38-68); and a specificity of 77%; 95% CI (54-100).

CONCLUSION

ΔVTIminiFC weakly predicted the effects of a fluid challenge of 15 mL kg-1 of crystalloid in anesthetized children under controlled mechanical ventilation.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France.Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France.Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.Department of Anesthesia and Intensive Care, Ramsay Generale de Sante, Sauvegarde Clinic, Lyon, France.Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France.Department of Anesthesia and Intensive Care, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France. Health Services and Performance Research laboratory (EA 7425 HESPER), Claude Bernard Lyon 1 University, Lyon, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31858641

Citation

Zorio, Violette, et al. "Does a Two-minute Mini-fluid Challenge Predict Fluid Responsiveness in Pediatric Patients Under General Anesthesia?" Paediatric Anaesthesia, vol. 30, no. 2, 2020, pp. 161-167.
Zorio V, Lebreton T, Desgranges FP, et al. Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia? Paediatr Anaesth. 2020;30(2):161-167.
Zorio, V., Lebreton, T., Desgranges, F. P., Bochaton, T., Desebbe, O., Chassard, D., Jacquet-Lagrèze, M., & Lilot, M. (2020). Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia? Paediatric Anaesthesia, 30(2), 161-167. https://doi.org/10.1111/pan.13793
Zorio V, et al. Does a Two-minute Mini-fluid Challenge Predict Fluid Responsiveness in Pediatric Patients Under General Anesthesia. Paediatr Anaesth. 2020;30(2):161-167. PubMed PMID: 31858641.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia? AU - Zorio,Violette, AU - Lebreton,Thibault, AU - Desgranges,François-Pierrick, AU - Bochaton,Thomas, AU - Desebbe,Olivier, AU - Chassard,Dominique, AU - Jacquet-Lagrèze,Matthias, AU - Lilot,Marc, Y1 - 2020/01/20/ PY - 2019/09/06/received PY - 2019/12/11/revised PY - 2019/12/15/accepted PY - 2019/12/21/pubmed PY - 2019/12/21/medline PY - 2019/12/21/entrez KW - echocardiography KW - fluid challenge KW - fluid responsiveness KW - hemodynamics KW - pediatric anesthesia SP - 161 EP - 167 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 30 IS - 2 N2 - BACKGROUND: Very little evidence for predictive markers of fluid responsiveness has been reported in children as compared to adults. The impact of hypovolemia or hypervolemia on morbidity has driven interest in the fluid challenge titration strategy. AIM: The objective of this study was to explore the ability of a 3 mL kg-1 mini-fluid challenge over 2 minutes to predict fluid responsiveness in children under controlled ventilation. METHODS: Children scheduled for surgery under general anesthesia were included and received a fluid challenge of 15 mL kg-1 of crystalloid prior to incision administered over 10 minutes in two steps: 3 mL kg-1 over 2 minutes then 12 mL kg-1 over 8 minutes. Fluid responsiveness was defined as a change of ≥10% in cardiac output estimated by left ventricular outflow tract velocity time integral (VTI) as measured by transthoracic ultrasound before and after the fluid challenge of 15 mL kg-1 . RESULTS: Of the 55 patients included in the analysis, 43 were fluid responders. The increase in the VTI after the mini-fluid challenge (ΔVTIminiFC) predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.77; 95% CI (0.63-0.87), P = .004. Considering the least significant change which was 7.9%; 95% CI (6-10), the threshold was 8% with a sensitivity of 53%; 95% CI (38-68); and a specificity of 77%; 95% CI (54-100). CONCLUSION: ΔVTIminiFC weakly predicted the effects of a fluid challenge of 15 mL kg-1 of crystalloid in anesthetized children under controlled mechanical ventilation. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/31858641/Does_a_two-minute_mini-fluid_challenge_predict_fluid_responsiveness_in_pediatric_patients_under_general_anesthesia L2 - https://doi.org/10.1111/pan.13793 DB - PRIME DP - Unbound Medicine ER -
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