Fluid challenge revisited

  title={Fluid challenge revisited},
  author={Jean Louis Vincent and Max Harry Weil},
  journal={Critical Care Medicine},
OBJECTIVE To discuss the rationale, technique, and clinical application of the fluid challenge. [] Key MethodDATA SOURCE Relevant literature from MEDLINE and authors' personal databases. STUDY SELECTION Studies on fluid challenge in the acutely ill.

Use of the Fluid Challenge in Critically Ill Adult Patients: A Systematic Review

It is indicated that the FC most commonly consists in infusing 500 mL of crystalloids or colloids in 20–30 minutes, and considered an increase in cardiac index ≥15% as a positive response, however, definite standards for FC administration and evaluation remain undefined.

What is a fluid challenge?

A fluid challenge identifies and simultaneously treats volume depletion, whilst avoiding deleterious consequences of fluid overload through its small volume and targeted administration.

Four phases of intravenous fluid therapy: a conceptual model.

A recently proposed model for fluid therapy in severe sepsis is reviewed and a framework by which it could be adopted for use in most situations where fluid management is required is proposed.

Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force

The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion.

Fluid Challenge During Anesthesia: A Systematic Review and Meta-analysis

The key components of FC including type of fluid (colloids, often 6% HES), volume (500 and 250 mL in non-GDT studies and GDT studies, respectively), and time of infusion (10 minutes) are quite standardized in operating room, however, pooled sensitivity and specificity of both PPV and SVV are limited.

Fluid challenges in intensive care: the FENICE study

An observational study conducted in ICUs around the world to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid and to compare the proportion of patients receiving further fluid administration based on the response to the FC.

Predicting Fluid Responsiveness in Children: A Systematic Review

Static variables did not predict fluid responsiveness in children, which was consistent with evidence in adults, but the evidence for dynamic variables based on plethysmography was inconclusive.

Methods of assessing fluid responsiveness in septic shock patients: a narrative review.

This study provides an overview of various methods for assessing fluid responsiveness and indicates those that potentially lead to haemodynamically guided fluid restrictive treatment that would prevent fluid overload in septic patients.

Title : Pharmacodynamic Analysis Of A Fluid Challenge

The global effect of the fluid challenge on CVP is greater in nonPharmacodynamics of a fluid challenge 3 responders but not its change ten minutes after the fluid infusion, and the maximal change in CO should be assessed one minute after the end of the fluids infusion.

Approach to Fluid Therapy in the Acute Setting

  • N. Yunos
  • Medicine, Biology
    Essentials of Accident and Emergency Medicine
  • 2019
The chapter aims to review the optimal approach to fluid therapy in the acute setting, from the understanding of the relevant basic sciences to the practice at the bedside.



Crystalloids vs. colloids in fluid resuscitation: a systematic review.

Overall, there is no apparent difference in pulmonary edema, mortality, or length of stay between isotonic crystalloid and colloid resuscitation between randomized clinical trials of adult patients requiring fluid resuscitation vs. colloids.


Until the results from such studies are available, physicians should probably be more concerned with ensuring that enough fluid is given to maintain perfusion than with which fluid they use to achieve it.

Morbidity in hospitalized patients receiving human albumin: A meta-analysis of randomized, controlled trials*

Albumin reduces morbidity in acutely ill hospitalized patients and can obscure the effects of albumin on clinical outcome in randomized trials, according to a meta-analysis of randomized trials.

Timing and volume of fluid administration for patients with bleeding following trauma.

No evidence from randomised controlled trials is found to support early or larger volume of intravenous fluid administration in uncontrolled haemorrhage in bleeding trauma patients.

Pulse pressure variations to predict fluid responsiveness: influence of tidal volume

ΔPP is a reliable predictor of fluid responsiveness in mechanically ventilated patients only when tidal volume is at least 8 ml/kg, and it best identified different behaviors at different tidal volume thresholds.

Clinical usefulness of respiratory variations in arterial pressure.

  • S. Magder
  • Medicine
    American journal of respiratory and critical care medicine
  • 2004
The major impetus for these tests came from the work of Perel and coworkers, who followed-up on a preliminary report by Coyle and coworkers (7), and defined the difference between maximum and minimum arterial systolic pressure during a respiratory cycle as syStolic pressure variation (SPV).

A comparison of albumin and saline for fluid resuscitation in the intensive care unit.

In patients in the ICU, use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days, with no significant differences between the groups.

Role of early fluid resuscitation in pediatric septic shock.

Rapid fluid resuscitation in excess of 40 mL/kg in the first hour following emergency department presentation was associated with improved survival, decreased occurrence of persistent hypovolemia, and no increase in the risk of cardiogenic pulmonary edema or adult respiratory distress syndrome in this group of pediatric patients with septic shock.

Small hemodynamic effect of typical rapid volume infusions in critically ill patients.

The effect of a typical rapid volume infusion on hemodynamics and left ventricular areas in patients admitted to the ICU for > 12 hrs is surprisingly small.

Hypoalbuminemia in Acute Illness: Is There a Rationale for Intervention?: A Meta-Analysis of Cohort Studies and Controlled Trials

There is no compelling basis to withhold albumin therapy if it is judged clinically appropriate, and further well-designed trials are needed to characterize the effects of albumin Therapy in hypoalbuminemic patients.