• Marc-Olivier Fischer, Vincent Bonnet, Emmanuel Lorne, Jean-Yves Lefrant, Olivier Rebet, Benoît Courteille, Charlotte Lemétayer, Jean-Jacques Parienti, Jean-Louis Gérard, Jean-Luc Fellahi, Jean-Luc Hanouz, ... more and French Hemodynamic Team. less
• Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France; EA 4650, Université de Caen Normandie, Esplanade de la Paix, CS 14 032, F-14 000 Caen, Fran... more ce. Electronic address: fischer-mo@chu-caen.fr. less
• J Crit Care. 2017 Aug 1; 40: 91-98.

PurposeThe main goal of this study was to assess whether maximal fluid infusion improves both oxygen delivery (DO2) and micro-circulatory parameters during hemodilution. The secondary objective was to assess the ability of baseline micro-circulatory parameters to predict oxygen consumption (VO2) response following fluid infusion.Materials And MethodsIn a postoperative cardiac ICU, patients received repeated fluid infusion until stroke volume (SV) was maximized. Before and after each fluid expansion, macro- (DO2, VO2) and micro-circulatory oxygenation parameters were recorded [central venous oxygen saturation (ScVO2), blood lactate, difference in veno-arterial carbon dioxide tension (P(v-a)CO2), somatic and cerebral oxygen saturation (rSO2)]. Patients were classified as VO2-Responders or VO2-Non-Responders according to an increase in VO2 above or below 15%, respectively.ResultsAfter maximal fluid infusion, all patients showed improved macro- and micro-circulatory oxygenation parameters, but VO2-Responders had lower values (especially for ScVO2 and cerebral rSO2). Only baseline ScVO2 and cerebral rSO2 were useful to predict the VO2 response to maximal fluid infusion (ROCAUC 0.80 (95% CI: 0.54-0.95, P=0.012) and 0.83 (95% CI: 0.57-0.96, P=0.001).ConclusionsMaximal fluid infusion improves macro- and micro-circulatory oxygenation parameters. For VO2-Responders, only ScVO2 and cerebral rSO2 could serve as markers of tissue hypoxia.Copyright © 2017 Elsevier Inc. All rights reserved.

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