Chest
Critical Care ReviewsPredicting Fluid Responsiveness in ICU Patients: A Critical Analysis of the Evidence
Section snippets
Selection of Studies To Be Evaluated
We collected studies investigating the predictive factors of fluid responsiveness in critically ill patients by doing a search in MEDLINE (from 1966). Studies were selected according to the following criteria: volume expansion performed in critically ill patients, patients classified in two groups (responders and nonresponders) according to the effects of volume expansion on stroke volume or on cardiac output, and comparison of responder and nonresponder patients characteristics before volume
Results
There were 406 fluid challenges in 334 patients (Table 1). Most of the patients were septic (55%) and receiving mechanical ventilation (84%). The decision of volume expansion was based on criteria listed in Table 2. Fluid administration was performed using colloid solutions (albumin, fresh frozen plasma, or hydroxyethylstarch) in 253 instances, and crystalloid solutions (serum saline solution or Ringer's lactate) in 153 instances (Table 1). In nine studies, the volume infused was predetermined
Discussion
The present analysis emphasizes the minimal clinical value of ventricular preload indicators and the higher value of dynamic parameters (testing the cardiovascular response to respiratory changes in pleural pressure) in predicting fluid responsiveness in critically ill patients. It has been suggested that a beneficial hemodynamic effect of volume expansion cannot be expected in critically ill patients with a RAP > 12 mm Hg17 and/or a PAOP > 12 mm Hg or > 15 mm Hg.15,18 In this regard, RAP and
ACKNOWLEDGMENT
The authors thank Dr. Denis Chemla for helpful discussion.
References (36)
- et al.
Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study
Am Heart J
(1988) - et al.
Measurements of right ventricular volumes during fluid challenge
Chest
(1990) - et al.
Respiratory variations in right atrial pressure predict the response to fluid challenge
J Crit Care
(1992) - et al.
Right ventricular end-diastolic volume as a predictor of the hemodynamic response to a fluid challenge
Chest
(1998) - et al.
Effectiveness of albumin vs normal saline as a test of volume responsiveness in post-cardiac surgery patients
J Crit Care
(1999) - et al.
Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock
Chest
(2001) - et al.
Misled by the wedge? The Swan-Ganz catheter and left ventricular preload
Chest
(1986) - et al.
The effects of valvular regurgitation on thermodilution ejection fraction measurements
Chest
(1992) - et al.
Mechanisms of cardiac contraction and relaxation
- et al.
The hemodynamic effect of rapid fluid infusion in critically ill patients
Surgery
(1981)
End-diastolic volume: a better indicator of preload in the critically ill
Arch Surg
End-diastolic volume vs pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients
J Trauma
Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension
Anesthesiology
The use of transesophageal echocardiography for preload assessment in critically ill patients
Anesth Analg
Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure
Am J Respir Crit Care Med
Volume replacement strategies on ICUs: results from a postal survey
Intensive Care Med
Practice parameters for hemodynamic support of sepsis in adult patients in sepsis
Crit Care Med
Hemodynamic support in septic shock
Intensive Care Med
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