Fluid Resuscitation: Think Microcirculation
The goal of fluid resuscitation in intensive care unit (ICU) patients is to restore effective tissue perfusion and oxygen delivery (DO2). Fluid resuscitation must be started as a first-line treatment in the management of septic or hemorrhagic shock. Fluid administration should be titrated to clinical endpoints of perfusion (such as capillary refill and urine output) and also to macrocirculatory parameters of global perfusion. It is recommended that fluids should be given only if changes in preload result in significant changes in stroke volume. However, assessment of the adequacy of resuscitation requires attention to both the macroand the microcirculation. Microcirculatory dysfunction is a central abnormality in septic and hemorragic shock and relationships between the macro- and microcirculations are complex. It is, therefore, impossible to predict the microvascular response after a positive fluid challenge in ICU patients without assessment of the microcirculation. However, techniques to monitor the microcirculation are not yet available for clinical practice.
KeywordsSeptic Shock Severe Sepsis Intensive Care Unit Patient Septic Patient Fluid Resuscitation
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