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Hypovolemia and Fluid Responsiveness

  • Armando Sarti
  • Simone Cipani
  • Massimo Barattini
Chapter

Abstract

Traditionally, fluid responsiveness has been assessed by graded volume loading, but this may easily lead to fluid overload. Whether to provide a fluid bolus is a critical decision of the utmost importance in the emergency and ICU setting. Cardiac filling pressures are poor predictors of preload, and neither central venous pressure nor pulmonary artery occlusion pressure can be used to predict fluid responsiveness in patients who breathe spontaneously or in patients on positive pressure ventilation. The echocardiographic appearance of a full-blown picture of hypovolemia is consistent with a small hyperkinetic fast-beating heart. Passive leg raising has been proposed as a preload-modifying maneuver without any potentially harmful fluid infusion. This maneuver is the only reliable, easy way to predict fluid responsiveness for the patient who breathes spontaneously. The only way to avoid useless or even harmful fluid load is simply to challenge the Frank–Starling relationship. The echocardiographic methods used to predict fluid responsiveness in mechanically ventilated patients are described. Aortic flow changes during stable mechanical ventilation are the most used parameter to assess fluid responsiveness. Echocardiography, with all the vital information on cardiovascular functional anatomy it provides, has become the best tool to assess volume status, predict fluid responsiveness, and guide fluid therapy in the emergency and ICU setting.

Keywords

Hypovolemia Heart–lung interaction in mechanical ventilation Fluid responsiveness Passive leg raising Echocardiographic criteria of fluid responsiveness 

Further Reading

  1. Carsetti A, Cecconi M, Rhodes A. Fluid bolus therapy: monitoring and predicting fluid responsiveness. Curr Opin Crit Care. 2015;21:388–94.CrossRefGoogle Scholar
  2. Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task Force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.CrossRefGoogle Scholar
  3. Charron C, Caille V, Jardin F, et al. Echocardiographic measurement of fluid responsiveness. Curr Opin Crit Care. 2006;12:249–54.CrossRefGoogle Scholar
  4. De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology. 2009;110:1092–7.CrossRefGoogle Scholar
  5. Fehil F, Broccard AF. Interactions between respiration and systemic hemodynamics. Part I: basic concepts. Intensive Care Med. 2009;35:45–54.CrossRefGoogle Scholar
  6. Feihl F, Broccard AF. Interactions between respiration and systemic hemodynamics. Part II: practical implications in critical care. Intensive Care Med. 2009;35:198–205.CrossRefGoogle Scholar
  7. Gerstle J, Shahul S, Mahmood F. Echocardiographically derived parameters of fluid responsiveness. Int Anesthesiol Clin. 2010;48(1):37–44.CrossRefGoogle Scholar
  8. Pinsky MR. Heart-lung interactions. Curr Opin Crit Care. 2007;13:528–31.CrossRefGoogle Scholar
  9. Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity. Curr Opin Crit Care. 2008;14:334–9.CrossRefGoogle Scholar
  10. Vignon P. Ventricular diastolic abnormalities in the critically ill. Curr Opin Crit Care. 2013;19:242–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Armando Sarti
    • 1
  • Simone Cipani
    • 2
  • Massimo Barattini
    • 2
  1. 1.Department of Anesthesia and Intensive CareSanta Maria Annunziata HospitalFlorenceItaly
  2. 2.Department of Anesthesia and Intensive CareSanta Maria Nuova HospitalFlorenceItaly

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