Effectiveness Of Predicting Fluid Responsiveness By Mini-fluid Challenge Test In Perioperative Children

Background: Rational volume management is the cornerstone of perioperative hemodynamics.Children have high metabolism and water requirements,which distinguish them from adults.However,about 50% of children receive inappropriate fluid volumes.The adult volume management is an intravenous infusion of 300-500 ml of fluid over 30 minutes to predict fluid responsiveness,so fluid challenge may invalidate the volume overload status of the infusion.In contrast,mini-fluid challenge can mitigate adverse outcomes in non-responders to fluid challenge due to the small volume of fluid challenge.Therefore,the proposed mini-fluid challenge provides a better solution for pediatric perioperative volume management.Aim: The objective of this study was to explore the ability of a 3 ml/kg lactated Ringer’s solution to predict the validity of mini-fluid challenge in children under controlled ventilation.Methods: The mini-fluid challenge was randomly divided into test and control groups.The test group was rehydrated using the mini-fluid challenge,the control group was rehydrated according to the 421 rule.Children aged 2-6 years who underwent elective laparoscopic hernia surgery under general anesthesia were included and received a fluid challenge of 3 ml/kg of crystalloid prior to incision administered in two steps: 1ml/kg at0.3ml/kg/min,followed by 2ml/kg at the same rate.HR,SBP,DBP,MAP,CO,SV,VTI were monitored and collected.Fluid responsiveness was defined as a change in SV of baseline(ΔSV)≥10% in SV measured by echocardiography after infusion of 3 ml/kg lactated Ringer’s solution.Results: A total of 66 children aged 2-6 years undergoing elective laparoscopic surgery were included in this study.There were nineteen(57.6%)responders and fourteen non-responders to fluid challenge in the test group.The increase in the ΔSV after the mini-fluid challenge predicted fluid responsiveness with an area under the ROC curve of0.944;95% confidence interval [CI]: 0.85-1.00,p<0.001,with a sensitivity of 89.5%and a specificity of 86.7%.Conclusion: ΔSV predicted the effects of a fluid challenge of 3 ml/kg crystalloid in laparoscopic surgery under mechanical ventilation.