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Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia?

Paediatric Anaesthesia Feb 26, 2020

Zorio V, Lebreton T, Desgranges FP, et al. - Whether a 3 mL kg−1 mini-fluid challenge over 2 minutes can predict fluid responsiveness in children under controlled ventilation, was investigated in this study. Participants were children scheduled for surgery under general anesthesia. These children were asked to receive a fluid challenge of 15 mL kg−1 of crystalloid before incision administered over 10 minutes in two steps: 3 mL kg−1 over 2 minutes then 12 mL kg−1 over 8 minutes. There were 55 participants in total, with 43 being fluid responders. The definition of fluid responsiveness was: an alteration of ≥ 10% in cardiac output estimated by left ventricular outflow tract velocity time integral (VTI) as recorded by transthoracic ultrasound prior to and following the fluid challenge of 15 mL kg−1. The rise in the VTI following the mini-fluid challenge (ΔVTIminiFC) predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.77. Taking the least significant change into account, which was 7.9%, the threshold was 8% with a sensitivity and a specificity of 53% and 77%, respectively. In this patient sample of anesthetized children under controlled mechanical ventilation, the effects of a fluid challenge of 15 mL kg−1 of crystalloid were weakly predicted by ΔVTIminiFC.
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