Abstract
Fluid administration is often the first therapeutic step in a patient with acute circulatory failure. Its goal is to increase cardiac preload, cardiac output and, ultimately, arterial oxygen delivery. However, the effects of volume expansion are variable. If it is of sufficient volume, it increases the mean systemic pressure, the upstream pressure of the systemic venous return. In the event of preload responsiveness of the two ventricles, it leads to an increase in systemic venous return and therefore of cardiac output. If haemodilution caused by the infusion of fluid is not too large and if the microvascular and mitochondrial functions are not excessively impaired, it may result in improved tissue oxygenation. In contrast, in the absence of preload responsiveness, fluid administration does not increase cardiac output and can only have deleterious effects. These harmful effects of the administration of fluid, which results in an increased fluid balance, have been clearly demonstrated. Fluids should therefore be regarded as drugs, the effect of which is inconstant and the deleterious side effects numerous. Basically, this justifies predicting before administering a volume expansion whether or not it will have the desired effect on cardiac output.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Monnet X, Teboul JL. My patient has received fluid. How to assess its efficacy and side effects? Ann Intensive Care. 2018;8(1):54.
Guyton AC, Lindsey AW, Abernathy B, Richardson T. Venous return at various right atrial pressures and the normal venous return curve. Am J Phys. 1957;189(3):609–15.
Magder S. Volume and its relationship to cardiac output and venous return. Crit Care. 2016;20:271.
Calvin JE, Driedger AA, Sibbald WJ. The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery. 1981;90(1):61–76.
Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121(6):2000–8.
Aya HD, Rhodes A, Chis Ster I, Fletcher N, Grounds RM, Cecconi M. Hemodynamic effect of different doses of fluids for a fluid challenge: a quasi-randomized controlled study. Crit Care Med. 2017;45(2):e161–8.
Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6(1):111.
Guerin L, Teboul JL, Persichini R, Dres M, Richard C, Monnet X. Effects of passive leg raising and volume expansion on mean systemic pressure and venous return in shock in humans. Crit Care. 2015;19:411.
Monnet X, Julien F, Ait-Hamou N, Lequoy M, Gosset C, Jozwiak M, Persichini R, Anguel N, Richard C, Teboul JL. Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders. Crit Care Med. 2013;41(6):1412–20.
Malbrain M, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, Teboul JL, Rice TW, Mythen M, Monnet X. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66.
Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, Payen D. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013;17(6):R278.
Chen CY, Zhou Y, Wang P, Qi EY, Gu WJ. Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis. Crit Care. 2020;24(1):80.
Sakr Y, Rubatto Birri PN, Kotfis K, Nanchal R, Shah B, Kluge S, Schroeder ME, Marshall JC, Vincent JL. Intensive care over nations I: higher fluid balance increases the risk of death from Sepsis: results from a large international audit. Crit Care Med. 2017;45(3):386–94.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53.
Jozwiak M, Silva S, Persichini R, Anguel N, Osman D, Richard C, Teboul JL, Monnet X. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med. 2013;41(2):472–80.
Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12(3):R74.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, et al. Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304–77.
Guidet B, Soni N, Della Rocca G, Kozek S, Vallet B, Annane D, James M. A balanced view of balanced solutions. Crit Care. 2010;14(5):325.
Monnet X, Cipriani F, Camous L, Sentenac P, Dres M, Krastinova E, Anguel N, Richard C, Teboul JL. The passive leg raising test to guide fluid removal in critically ill patients. Ann Intensive Care. 2016;6(1):46.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Monnet, X., Teboul, J. (2021). Fluid Responsiveness and Dynamic Tests: Physiological Background. In: Kirov, M.Y., Kuzkov, V.V., Saugel, B. (eds) Advanced Hemodynamic Monitoring: Basics and New Horizons. Springer, Cham. https://doi.org/10.1007/978-3-030-71752-0_15
Download citation
DOI: https://doi.org/10.1007/978-3-030-71752-0_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-71751-3
Online ISBN: 978-3-030-71752-0
eBook Packages: MedicineMedicine (R0)