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Preload Dependency Dynamic Indices

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Hemodynamic Monitoring in the ICU

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Abstract

Volume expansion was formerly assessed by invasive cardiac output monitoring and intracardiac pressure measurement, following the concept of “fluid challenge” [1]. Recently, fluid responsiveness was then evaluated in response to volume expansion. The recent concept is based on the Starling curve. For instance, following a volume expansion, a patient may be situated on the ascending portion of the curve (with a significant increase in cardiac output without massive increases in filling pressures) or may be located on the flat portion of the curve (with a small increase in cardiac output along with drastically increased filling pressures) [2]. In the past, no indication was predictive of the potential effectiveness of volume expansion, and the only evidence used to guide fluid therapy was the preload indices, also known as “static” indices. However, the central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) were never shown to reliably predict the hemodynamic benefit of volume expansion [3, 4] to a greater extent than ventricular diameter or surface measurements [5, 6]. Although a low preload value could still achieve a volume expansion in shocked (and not yet resuscitated) patients, the use of static preload indices is currently not recommended to guide fluid therapy in the ICU. In fact, this practice is likely to lead to the incorrect administration of intravenous fluids and to result in an increased risk or aggravation of pulmonary edema, hypoxemia, or ARDS [7, 8].

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    Raphael Giraud & Karim Bendjelid

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Giraud, R., Bendjelid, K. (2016). Preload Dependency Dynamic Indices. In: Hemodynamic Monitoring in the ICU. Springer, Cham. https://doi.org/10.1007/978-3-319-29430-8_6

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