(i) Purpose. The fluid challenge (FC) is a well-established test of preload reserve.Only limited data exist in regard to the FC efficacy\nbased on infusion time. Slow administration may be associated with lack of effect based on fluid redistribution and external\nconditions changes. On the contrary, fast administration may lead to brisk fluid overload and damage to the endothelium and\nendothelial glycocalyx (EG). The aim of this trial was to compare the FC infusion time on its hemodynamic effects and EG. (ii)\nMethods. Prospective randomized single-center trial of fast (5-10 minutes) versus slow (20-30 minutes) administration of 500ml\nbalanced crystalloid FCin spinal surgery (cohort OR) and septic shock (cohort SEP) patients.Hemodynamic response was assessed\nusing standard monitoring and blood flow measurements; damage to EG was assessed using the perfused boundary region (PBR)\nvia intravital microscopy monitoring in the sublingual region within relevant time points ranging up to 120 minutes. (iii) Results.\nOverall, 66 FCs in 50 surgical and 16 septic patients were assessed. Fluid administration was associated with increase of PBR in\ngeneral (1.9 (1.8-2.1) vs. 2.0 (1.8-2.2); p= 0.008). These changes were transient in OR cohort whereas they were long-lasting in septic\nfluid responders.Therate of fluidresponsiveness after fast versus slowadministrationwas comparable in global population (15 (47%)\nvs. 17 (50%); p=0.801) as well as in both cohorts. (iv) Conclusions. Fluid challenge administration was associatedwith increased PBR\n(and presumable EG volume changes) which normalized within the next 60 minutes in surgical patients but remained impeded\nin septic fluid responders. The fluid responsiveness rate after fast and slow FC was comparable, but fast administration tended to\ninduce higher, though transient, response in blood pressure.
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