• Antonio Messina, Salvatore M Romano, Eleonora Bonicolini, Davide Colombo, Gianmaria Cammarota, Marco Chiostri, Della Corte Francesco F, Paolo Navalesi, Didier Payen, and Stefano Romagnoli.
• From the Department of Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara (AM, DC, GC, FDC), Department of Experimental and Clinical Medicine, Unit of Internal Medicine and Cardiology, University of Florence (SMR, MC), Department of Anesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence (EB, SR), Department of Translational Medicine, Università del Piemonte Orientale 'Amedeo Avogadro', Novara (FDC), Department of Anesthesia and Intensive Care Medicine (PN), Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (PN); and Department of Anesthesiology and Critical Care Medicine, Lariboisière Hospital, University of Paris VII, Paris, France (DP).
• Eur J Anaesthesiol. 2017 Nov 1; 34 (11): 755-763.

BackgroundDuring a fluid challenge, the changes in cardiac performance and peripheral circulatory tone are closely related to the position of the ventricle on the Frank-Starling curve. Some patients have a good haemodynamic response to a fluid challenge, others hardly any response. The early haemodynamic effects of a fluid challenge could predict the final response before the entire fluid volume has been administered.ObjectiveTo assess whether a multivariate logistic regression model, including pulse pressure variation (PPV), cardiac cycle efficiency (CCE), arterial elastance and the difference between the dicrotic pressure and both systolic and mean arterial pressure (SAP - Pdic and MAP - Pdic) can predict cardiac responsiveness early during a fluid challenge in comparison with the standard procedure described elsewhere.DesignObservational study.SettingElective surgical patients undergoing laparotomy, enrolled in two Italian University Hospitals.PatientsFifty adult surgical patients, ventilated with a lung protective strategy, were enrolled and data from 46 were analysed.InterventionsA fluid challenge consisting of 500 ml of crystalloid infused over 10 min.Main Outcome Measures And AnalysisThe changes in CCE, arterial elastance, SAP - Pdic and MAP - Pdic were compared using analysis of variance. A multivariate logistic regression analysis utilising baseline values and the first minute measuring a variation statistically significant for the considered variables.ResultsAt baseline, PPV correctly identified 70% of patients (89% of non-responders; 42% of responders). The model, including baseline PPV, ΔCCE and ΔSAP - Pdic, correctly identified the efficiency of fluid challenge in 87% of patients (84.2% of responders; 92.5 of non-responders) after 5 min from fluid challenge infusion.ConclusionIn this pilot study conducted in a population of surgical patients mechanically ventilated with a VT less than 8 ml kg, a dynamic model of fluid challenge assessment, including PPV, ΔCCE and ΔSAP - Pdic, enhances the prediction of fluid challenge response after 5 min of a 10-min administration.Trial RegistrationACTRN12616001479493.

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