Hemodynamic parameters to guide fluid therapy

By P. Marik, X. Monnet, J. Teboul. Annals of Intensive Care, 2011

681 citations recorded by the source corpus.

The clinical determination of the intravascular volume can be extremely difficult in critically ill and injured patients as well as those undergoing major surgery. This is problematic because fluid loading is considered the first step in the resuscitation of hemodynamically unstable patients. Yet, multiple studies have demonstrated that only approximately 50% of hemodynamically unstable patients in the intensive care unit and operating room respond to a fluid challenge. Whereas under-resuscitation results in inadequate organ perfusion, accumulating data suggest that over-resuscitation increases the morbidity and mortality of critically ill patients. Cardiac filling pressures, including the central venous pressure and pulmonary artery occlusion pressure, have been traditionally used to guide fluid management. However, studies performed during the past 30 years have demonstrated that cardiac filling pressures are unable to predict fluid responsiveness. During the past decade, a number of dynamic tests of volume responsiveness have been reported. These tests dynamically monitor the change in stroke volume after a maneuver that increases or decreases venous return (preload) and challenges the patients' Frank-Starling curve. These dynamic tests use the change in stroke volume during mechanical ventilation or after a passive leg raising maneuver to assess fluid responsiveness. The stroke volume is measured continuously and in real-time by minimally invasive or noninvasive technologies, including Doppler methods, pulse contour analysis, and bioreactance.

Subfields: Biomedical Engineering, Epidemiology, Surgery

View Paper: https://www.semanticscholar.org/paper/d1f64aed9a566ee4448b427c4379d29696d6a79f

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Citations in the corpus

Does the Central Venous Pressure Predict Fluid Responsiveness? An Updated Meta-Analysis and a Plea for Some Common Sense* (2013, background): “meta-analysis, the concept of fluid responsiveness has become well accepted, and a number of studies have been published investigating the role of various techniques to assess fluid responsiveness (6).”
Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine (2014, methodology): “The detection of preload responsiveness can be achieved through the use of several different indices [72], but the presence of preload responsiveness does not imply that fluids can be administered safely or that they should be administered at all.”
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012 (2013, background): “Dynamic tests to assess patients’ responsiveness to fluid replacement have become very popular in recent years in the ICU [131].”