ArticleAnnals of intensive care2019
How to detect a positive response to a fluid bolus when cardiac output is not measured?
Article in Annals of intensive care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- ESICM guidelines on circulatory shock and hemodynamic monitoring 2025.Intensive care medicine · 2025Guideline
- Fluid challenge in critically ill patients receiving haemodynamic monitoring: a systematic review and comparison of two decades.Critical care (London, England) · 2022Pooled it
- Concerns regarding the definition of fluid responsiveness incorporating mean arterial pressure in mechanically ventilated shock patients.Critical care (London, England) · 2026Article
- Unnecessary fluid therapy in patients with shock: Five classic fluid pitfalls and five ways to do it better.Annals of intensive care · 2026Review
- Why do we use transpulmonary thermodilution and pulmonary artery catheter in severe shock patients?Annals of intensive care · 2025Article
- Are We Always Right? Evaluation of the Performance and Knowledge of the Passive Leg Raise Test in Detecting Volume Responsiveness in Critical Care Patients: A National German Survey.Journal of clinical medicine · 2024Article
- Consistency of data reporting in fluid responsiveness studies in the critically ill setting: the CODEFIRE consensus from the Cardiovascular Dynamic section of the European Society of Intensive Care Medicine.Intensive care medicine · 2024Article
- How I personalize fluid therapy in septic shock?Critical care (London, England) · 2023Review
- Anesthetic management of patients with sepsis/septic shock.Frontiers in medicine · 2023Review
- A plea for personalization of the hemodynamic management of septic shock.Critical care (London, England) · 2022Review
- Novel Methods for Predicting Fluid Responsiveness in Critically Ill Patients-A Narrative Review.Diagnostics (Basel, Switzerland) · 2022Review
- Management of sepsis and septic shock in the emergency department.Internal and emergency medicine · 2021Review
- Letter to the Editor: Stroke volume is the key measure of fluid responsiveness.Critical care (London, England) · 2021Article
- Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?Journal of anesthesia · 2020Review
- Prediction of fluid responsiveness in spontaneously breathing patients.Annals of translational medicine · 2020Review
- Evaluation of radial artery pulse pressure effects on detection of stroke volume changes after volume loading maneuvers in cardiac surgical patients.Annals of translational medicine · 2020Article
- Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina.Annals of intensive care · 2020Article
- Systematic assessment of fluid responsiveness during early septic shock resuscitation: secondary analysis of the ANDROMEDA-SHOCK trial.Critical care (London, England) · 2020Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVolume expansion is aimed at increasing cardiac output (CO), but this variable is not always directly measured. We assessed the ability of changes in arterial pressure, pulse pressure variation (PPV) and heart rate (HR) or of a combination of them to detect a positive response of cardiac output (CO) to fluid administration.
methodsWe retrospectively included 491 patients with circulatory failure. Before and after a 500-mL normal saline infusion, we measured CO (PiCCO device), HR, systolic (SAP), diastolic (DAP), mean (MAP) and pulse (PP) arterial pressure, PPV, shock index (HR/SAP) and the PP/HR ratio.
resultsThe fluid-induced changes in HR were not correlated with the fluid-induced changes in CO. The area under the receiver operating characteristic curve (AUROC) for changes in HR as detectors of a positive fluid response (CO increase ≥ 15%) was not different from 0.5. The fluid-induced changes in SAP, MAP, PP, PPV, shock index (HR/SAP) and the PP/HR ratio were correlated with the fluid-induced changes in CO, but with r < 0.4. The best detection was provided by increases in PP, but it was rough (AUROC = 0.719 ± 0.023, best threshold: increase ≥ 10%, sensitivity = 72 [66-77]%, specificity = 64 [57-70]%). Neither the decrease in shock index nor the changes in other indices combining changes in HR, shock index, PPV and PP provided a better detection of a positive fluid response than changes in PP.
conclusionA positive response to fluid was roughly detected by changes in PP and not detected by changes in HR. Changes in combined indices including the shock index and the PP/HR ratio did not provide a better diagnostic accuracy.
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