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Fluid Strategies in the FREE

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The Focused Rapid Echocardiographic Evaluation (FREE) is both an ultrasound exam and a style of resuscitation. It allows using fluid, vasoconstrictors, and inotropes together, personalized to the patient. It aims to optimize flow across the capillary beds by considering both arterial delivery and venous return. Treatment recommendations for fluid can change based on the strategy. Fluid-liberal strategies make sense early in shock, if there is clear evidence of end-organ hypoperfusion, and if severe respiratory failure is not a primary issue. Conversely fluid-conservative therapies are reasonable after the primary cause of shock has been addressed, and when severe respiratory failure is present. This chapter describes the resuscitation philosophy behind the FREE and how to select the correct fluid strategy. The following chapters discuss how to incorporate the strategy and echo to generate treatment recommendations.


  • FREE
  • CVP
  • RAP
  • MAP
  • Fluid bolus
  • Fluid liberal
  • Fluid conservative

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  • DOI: 10.1007/978-3-030-74687-2_25
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Fig. 1
Fig. 2



Cardiac output


Central venous pressure


Oxygen delivery


Focused Rapid Echocardiographic Evaluation

HR :

Heart rate


Right atrial pressure


Stroke volume


Systemic vascular resistance


Volume responsiveness

Suggested Reading

  • Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80. PMID: 25432556

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  • Murthi SB, Hess JR, Hess A, Stansbury LG, Scalea TM. Focused rapid echocardiographic evaluation versus vascular catheter-based assessment of cardiac output and function in critically ill trauma patients. J Trauma Acute Care Surg. 2012;72(5):1158–64. PMID: 22673240

    CrossRef  PubMed  Google Scholar 

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Correspondence to Sarah B. Murthi .

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Anderson, B., Murthi, S.B. (2021). Fluid Strategies in the FREE. In: Salerno, A., Haase, D.J., Murthi, S.B. (eds) Atlas of Critical Care Echocardiography. Springer, Cham.

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  • Print ISBN: 978-3-030-74685-8

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