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Prediction of fluid responsiveness: an update
Xavier Monnet1, Paul E Marik2, Jean-Louis Teboul3
1Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, Inserm UMR_S999, Paris-Sud University, 78, rue du Général Leclerc, 94 270, Le Kremlin-Bicêtre, France. xavier.monnet@aphp.fr.
Annals of Intensive Care
|November 19, 2016
Summary
Predicting fluid responsiveness is crucial in acute circulatory failure. Dynamic tests, unlike static measures, help clinicians avoid fluid overload and make informed decisions about fluid administration.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Fluid administration in acute circulatory failure requires careful consideration due to risks of overload.
- Static preload markers like central venous pressure are unreliable for predicting fluid responsiveness.
- Dynamic physiological tests offer a more accurate approach to fluid management.
Approach:
- Dynamic tests assess cardiac output response to transient preload changes.
- Methods include passive leg raising, end-expiratory occlusion, and pulse/stroke volume variations.
- These techniques leverage heart-lung interactions or small fluid challenges.
Key Points:
- Dynamic tests are superior to static measures for guiding fluid therapy.
- Passive leg raising and end-expiratory occlusion are well-supported dynamic methods.
- These tests help prevent fluid overload and optimize cardiac output.
Conclusions:
- Clinicians should utilize dynamic tests to predict fluid responsiveness in critically ill patients.
- Choosing the appropriate dynamic test depends on patient status and monitoring capabilities.
- Informed fluid management decisions improve patient outcomes in circulatory failure.
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