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. 2022 Jun 21;26(1):186.
doi: 10.1186/s13054-022-04056-3.

Fluid challenge in critically ill patients receiving haemodynamic monitoring: a systematic review and comparison of two decades

Antonio Messina  1   2 , Lorenzo Calabrò  3 , Luca Pugliese  3 , Aulona Lulja  3 , Alexandra Sopuch  3 , Daniela Rosalba  4 , Emanuela Morenghi  3   5 , Glenn Hernandez  6 , Xavier Monnet  7   8   9 , Maurizio Cecconi  3   5
Affiliations

Fluid challenge in critically ill patients receiving haemodynamic monitoring: a systematic review and comparison of two decades

Antonio Messina et al. Crit Care. .

Abstract

Introduction: Fluid challenges are widely adopted in critically ill patients to reverse haemodynamic instability. We reviewed the literature to appraise fluid challenge characteristics in intensive care unit (ICU) patients receiving haemodynamic monitoring and considered two decades: 2000-2010 and 2011-2021.

Methods: We assessed research studies and collected data regarding study setting, patient population, fluid challenge characteristics, and monitoring. MEDLINE, Embase, and Cochrane search engines were used. A fluid challenge was defined as an infusion of a definite quantity of fluid (expressed as a volume in mL or ml/kg) in a fixed time (expressed in minutes), whose outcome was defined as a change in predefined haemodynamic variables above a predetermined threshold.

Results: We included 124 studies, 32 (25.8%) published in 2000-2010 and 92 (74.2%) in 2011-2021, overall enrolling 6,086 patients, who presented sepsis/septic shock in 50.6% of cases. The fluid challenge usually consisted of 500 mL (76.6%) of crystalloids (56.6%) infused with a rate of 25 mL/min. Fluid responsiveness was usually defined by a cardiac output/index (CO/CI) increase ≥ 15% (70.9%). The infusion time was quicker (15 min vs 30 min), and crystalloids were more frequent in the 2011-2021 compared to the 2000-2010 period.

Conclusions: In the literature, fluid challenges are usually performed by infusing 500 mL of crystalloids bolus in less than 20 min. A positive fluid challenge response, reported in 52% of ICU patients, is generally defined by a CO/CI increase ≥ 15%. Compared to the 2000-2010 decade, in 2011-2021 the infusion time of the fluid challenge was shorter, and crystalloids were more frequently used.

Keywords: Critically ill patients; Fluid bolus; Fluid challenge; Fluid responsiveness; Fluids.

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Conflict of interest statement

Dr. Messina received travel expenses and registration for meetings, congresses, and courses and lecture fees from Vygon, Edwards, Philips, and Getinge. Xavier Monnet is a member of the medical advisory board of Pulsion Medical Systems (Getinge), and has given lectures for Baxter. Prof. Cecconi is a consultant of Edwards Lifesciences (Directed Systems Consultancy).

Figures

Fig. 1
Fig. 1
Flow of the studies; *Reasons for studies' exclusion are reported in the Supplementary materials
Fig. 2
Fig. 2
Percentage of studies in the two decades adopting different infusion timings. Fluid challenge, fluid challenge
See this image and copyright information in PMC

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