Une Mini-Epreuve de remplissage par 100 ml de Cristalloïdes prédit la réponse au remplissage au bloc opératoire

Abstract : Background: Mini-fluid challenge of 100ml colloids is thought to predict the effects of larger amounts of fluid (500ml) in intensive care units. This study sought to determine whether a low quantity of crystalloid (50 and 100ml) could predict the effects of 250ml crystalloid in mechanically ventilated patients in the operating room. Methods: a total of 44 mechanically ventilated patients undergoing neurosurgery were included. Volume expansion (250ml saline 0.9%) was given to maximize cardiac output during surgery. Stroke volume index (monitored using pulse contour analysis) and pulse pressure variations were recorded before and after 50ml infusion (given for 1min), after another 50ml infusion (given for 1min), and finally after 150ml infusion (total = 250ml). Changes in stroke volume index induced by 50, 100, and 250ml were recorded. Positive fluid challenges were defined as an increase in stroke volume index of 10% or more from baseline after 250ml. Results: a total of 88 fluid challenges were performed (32% of positive fluid challenges). Changes in stroke volume index induced by 100ml greater than 6% (gray zone between 4 and 7%, including 19% of patients) predicted fluid responsiveness with a sensitivity of 93% (95% CI, 77 to 99%) and a specificity of 85% (95% CI, 73 to 93%). The area under the receiver operating curve of changes in stroke volume index induced by 100ml was 0.95 (95% CI, 0.90 to 0.99) and was higher than those of changes in stroke volume index induced by 50ml (0.83 [95% CI, 0.75 to 0.92]; P = 0.01) and pulse pressure variations (0.65 [95% CI, 0.53 to 0.78]; P < 0.005). Conclusions: changes in stroke volume index induced by rapid infusion of 100ml crystalloid predicted the effects of 250ml crystalloid in patients ventilated mechanically in the operating room.
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Master Thesis
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Hugues de Courson. Une Mini-Epreuve de remplissage par 100 ml de Cristalloïdes prédit la réponse au remplissage au bloc opératoire. Médecine humaine et pathologie. 2017. ⟨dumas-01657531⟩

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