• A Smorenberg, Thomas G V Cherpanath, Bart F Geerts, Robert B de Wilde, Jos R Jansen, Jacinta J Maas, and A B Johan Groeneveld.
• 1Department of Internal Medicine, Ziekenhuis Amstelland, Amstelveen, the Netherlands 2Department of Intensive Care, Amsterdam Medical Centre, Amsterdam, the Netherlands 3Department of Aanesthesiology, Amsterdam Medical Centre, Amsterdam, the Netherlands 4Department of Intensive Care, Leiden University Medical Centre, Leiden, the Netherlands 5Department of Intensive Care, Erasmus Medical Centre, Rotterdam, the Netherlands.
• Shock. 2015 Oct 1;44 Suppl 2:19.

IntroductionThe mini-fluid challenge may predict fluid responsiveness with minimum risk of fluid overloading. However, the amount of fluid, as well as the best manner to evaluate the effect are unclear. In this prospective observational pilot study, the value of changes in pulse contour cardiac output (CO) measurements during mini-fluid challenges is investigated.MethodsTwenty-one patients during mechanical ventilation after elective cardiac surgery were subsequently given 10 intravenous boluses of 50 mL of hydroxyethyl starch with a total of 500 mL per patient. We measured CO by Modelflow (FMS, COm) and PulseCO (LiDCO, COli), before and after one minute after each fluid bolus. We analysed the smallest volume that was predictive of fluid responsiveness. A positive fluid response was defined as an increase in CO of >10% after 500 mL fluid infusion.ResultsFifteen patients (71%) were COm responders and 13 patients (62%) COli responders. An increase in COm after 150 mL of fluid >5.0% yielded a positive and negative predictive value (PPV and NPV) of 100% (area under the curve AUC = 1.00, P < 0.001). In contrast, an increase in COli >6.3% after 200 mL was able to predict a fluid response in COli after 500 mL with a PPV of 81% and NPV of 100% (AUC = 0.88, P = <0.001).ConclusionThe use of less invasive Modelflow pulse contour cardiac output measurements in a mini- fluid challenge of only 150 mL can predict fluid responsiveness and may reduce unnecessary fluid loading. It seems to perform better than PulseCO in this respect.

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