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Fluid Challenge

Fluid Challenge. Mimi, Connie and Pat. What is fluid challenge?. Fluid challenge is a diagnostic procedure used to identify a hypovolaemic condition.

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Fluid Challenge

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  1. Fluid Challenge Mimi, Connie and Pat

  2. What is fluid challenge? • Fluid challenge is a diagnostic procedure used to identify a hypovolaemic condition. • If hypovolaemia is the cause of hypotension, rapidly administering fluids should result in a change of the patient’s condition, indicating the need for further fluid resuscitation.

  3. Continued Fluid challenges require the definition of four components: • The type of fluid to be administered. • The rate of fluid infusion (e.g., 500-1000ml in 30mins). • The end points (e.g., mean arterial pressure of > 70mm Hg, heart rate of < 110 beats/min). • The safety limits (e.g. development of pulmonary oedema).

  4. Why fluid challenge is given? Crystalloids, or colloids, can be harmful if administered in insufficient or excessive amount. If fluid loss is under corrected, the patient will develop hypovolaemia, which may lead to renal impairment and other complications. Over correction can lead to pulmonary oedema. Fluid challenge allows prompt correction of fluid deficits, reducing risk of fluid overload or under correction.

  5. Continued Gradual hypovolaemia can cause hypotension. Fluid challenge can be needed to determine if the reduced urinary output is due to hypovolaemia. If hypovolaemia is confirmed, appropriate correction is effected.

  6. Types of fluid used • Crystalloids and colloids are used for intravenous drips. • Crystalloids form a true solution, and pass freely through a semipermeable membrane. They contain water and electrolytes, and stay in the intravascular compartment a shorter time than colloids. • Saline 0.9%, Dextrose 5%, Hartman’s Solution are Crystalloids. • Crystalloids are useful in maintaining fluid balance – such as, postoperatively, when a patient is not drinking - or in conjunction with colloids to replace intravascular volume, after blood loss.

  7. Continued • Crystalloids are useful in maintain fluid balance – for example, postoperatively when a patient is not drinking- or in conjunction with colloid to replace intravascular volume rapidly after sudden blood loss. • Colliods are substances that do not dissolve into a true solution and do not pass through a semipermeable membrane. Colliod solutions tend to stay in the intravascular compartment for longer than crystalloids, and therefore less volume is needed. Dextrans, Gelatines, and Hydroxyethyl starches are example of Colliods.

  8. References • Fluid challenge, available from www.sprtanburgens.com/protocol • Fluid challenge revisted, available from www.ncbI.nlm.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 • Webb, A.N. (2000) Critical care. Vol. 4 (supplementary 2): P 26-32. • Shami, S and Derbon, T. (1997) Understanding fluid balance. British Medical Journal. LMS

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