Cardiothoracic & vascular anesthesia
Incidence, predictability, and outcomes of systemic venous congestion following a fluid challenge in initially fluid-tolerant preload-responders after cardiac surgery: a pilot trial
Authors' conclusion
Post-PLR PVPI effectively predicts fluid-induced early-VC in fluid-tolerant preload-responders, identifying those with poor RVDR.
Study context
- Population
- Mechanically ventilated, fluid-tolerant preload-responsive patients with acute circulatory failure within 6 h of intensive care unit (ICU) admission after elective open-heart surgery
- Participants
- 40 consecutive patients
- Exposure
- Early-VC vs no early-VC after 7 ml/kg Ringer's Lactate over 10 min
- Outcome
- Incidence of VC (PVPI ≥ 50%) post-infusion (early-VC)
- Follow-up
- 2 min post-infusion
Methodological detailssingle-center, pilot, Retrospectively registered
- Single-center
- Pilot
- Retrospectively registered
Main finding
As reported in the abstract
Incidence of early-VC
Patients developing early-VC
45%
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Values |
|---|---|
| Prediction of early-VC by post-PLR PVPI | Post-PLR PVPI AUC 0.998 · threshold 44.3% |
- Prediction of early-VC by post-PLR portal vein pulsatility index (PVPI): p < 0.001
Venous congestion (VC) at 20 min
- VC persisting
- 5%
Acute kidney injury (AKI) and severe AKI · 7 days
- AKI
- One-third
- Severe AKI
- 17.5%
- Higher incidence of severe AKI in early-VC patients
ICU length of stay (LOS)
- Median ICU LOS (days)
- 4
Haemodynamics in early-VC patients
- PVPI remained elevated at 20 min in early-VC (left-ventricular outflow tract velocity time integral (LVOT-VTI) back to baseline in both)
- P < 0.001
- LVOT-VTI vs PVPI regression: similar slopes
- P = 0.755
- LVOT-VTI vs PVPI regression: different intercepts
- P < 0.001
- Higher central venous pressure, lower mean perfusion pressure, worse baseline RV function in early-VC
Original publication
Incidence, predictability, and outcomes of systemic venous congestion following a fluid challenge in initially fluid-tolerant preload-responders after cardiac surgery: a pilot trial. Crit Care. Published 22 October 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →