Time course of fluid responsiveness in sepsis: the fluid challenge revisiting (FCREV) study

Claire Roger, Laurent Zieleskiewicz, Christophe Demattei, Karim Lakhal, Gael Piton, Benjamin Louart, Jean-Michel Constantin, Russell Chabanne, Jean-Sébastien Faure, Yazine Mahjoub, Isabelle Desmeulles, Hervé Quintard, Jean-Yves Lefrant, Laurent Muller, AzuRea Group, Claire Roger, Laurent Zieleskiewicz, Karim Lakhal, Benjamin Louart, Jean-Michel Constantin, Russell Chabanne, Jean-Sébastien Faure, Yazine Mahjoub, Hervé Quintard, Jean-Yves Lefrant, Laurent Muller, Claire Roger, Laurent Zieleskiewicz, Christophe Demattei, Karim Lakhal, Gael Piton, Benjamin Louart, Jean-Michel Constantin, Russell Chabanne, Jean-Sébastien Faure, Yazine Mahjoub, Isabelle Desmeulles, Hervé Quintard, Jean-Yves Lefrant, Laurent Muller, AzuRea Group, Claire Roger, Laurent Zieleskiewicz, Karim Lakhal, Benjamin Louart, Jean-Michel Constantin, Russell Chabanne, Jean-Sébastien Faure, Yazine Mahjoub, Hervé Quintard, Jean-Yves Lefrant, Laurent Muller

Abstract

Background: Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC.

Methods: This is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline (T0), at the end of FC (T10), then 10 (T20) and 20 min (T30) after the end of FC.

Results: From May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43-63], median SOFA score 10 [8-12]). Among the 76/143 (53%) patient responders to FC at T10, 37 patients were transient responders (TR), i.e., became non-responders (NR) at T30 (49%, 95%CI = [37-60]), and 39 (51%, 95%CI = [38-62]) patients were persistent responders (PR), i.e., remained responders at T30. Among the 67 NR at T10, 4 became responders at T30, (6%, 95%CI = [1.9-15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups.

Conclusions: This study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent.

Trial registration: ClinicalTrials.gov , NCT02116413 . Registered on April 16, 2014.

Keywords: Echocardiography; Fluid challenge; Fluid responsiveness; ICU; Shock.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design. MAP, mean arterial pressure (mmHg); HR, heart rate (beat per minute), TTE, transthoracic echocardiography; Hb, patient blood hemoglobin (g/dL)
Fig. 2
Fig. 2
Study flow chart
Fig. 3
Fig. 3
Distribution of responders and non-responders to fluid challenge over time, according to velocity time integral (VTI) measurement at T10, T20 and T30
Fig. 4
Fig. 4
Velocity time integral (VTI) course over time in non-responders (NR), transient responders (TR), and persistent responders (PR). *Difference between VTI value at baseline between NR, TR, and NR groups (p = 0.0003). §Significant interaction between time and groups (p < 0.0001): stability of VTI over time in the NR group, VTI increase from T0 to T10, and subsequent decrease from T10 to T30 in TR and PR groups, with crossing curves between T10 and T20

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