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Cardiopulmonary interactions and volume status assessment

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Abstract

Assessment of the hemodynamics and volume status is an important daily task for physicians caring for critically ill patients. There is growing consensus in the critical care community that the “traditional” methods—e.g., central venous pressure or pulmonary artery occlusion pressure—used to assess volume status and fluid responsiveness are not well supported by evidence and can be misleading. Our purpose is to provide here an overview of the knowledge needed by ICU physicians to take advantage of mechanical cardiopulmonary interactions to assess volume responsiveness. Although not perfect, such dynamic assessment of fluid responsiveness can be helpful particularly in the passively ventilated patients. We discuss the impact of phasic changes in lung volume and intrathoracic pressure on the pulmonary and systemic circulation and on the heart function. We review how respirophasic changes on the venous side (great veins geometry) and arterial side (e.g., stroke volume/systolic blood pressure and surrogate signals) can be used to detect fluid responsiveness or hemodynamic alterations commonly encountered in the ICU. We review the physiological limitations of this approach.

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The author has no financial relationship to disclose related to the topic of this review.

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  1. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA

    Alain F. Broccard

  2. Critical Care and Respiratory Services, Fairview SouthDale Hospital, Edina, MN, 55435, USA

    Alain F. Broccard

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Broccard, A.F. Cardiopulmonary interactions and volume status assessment. J Clin Monit Comput 26, 383–391 (2012). https://doi.org/10.1007/s10877-012-9387-4

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