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Measurements of Fluid Requirements with Cardiovascular Challenges

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Cardiopulmonary Monitoring

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Abstract

Fluid administration is the first-line treatment in most cases of acute circulatory failure. However, this treatment poses two problems. The first is that it leads inconsistently to the increase in cardiac output that was expected. The second problem is that excessive fluid administration, which leads to increased fluid balance, worsens the prognosis of critically ill patients. Thus, apart from obvious fluid losses, hypovolemic shock state or the initial phase of the septic shock state, it appears logical to predict before infusing fluid that it will increase cardiac output static markers of cardiac preload, such as central venous pressure, are ineffective for this purpose, and several dynamic tests or indices have been developed. Changes in arterial pulse pressure or the diameter of the inferior and superior venae cavae in mechanically ventilated patients suffer from very strict conditions of use. The passive leg raising test and the respiratory occlusion tests act as internal preload tests and have broader indications. They must be performed by directly measuring the cardiac output. For optimal use, clinicians should be aware of the indications, contraindications, and limitations of these tests as well as how to perform them.

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Conflicts of Interest

Profs. Monnet and Teboul are members of the Medical Advisory Board of Pulsion Medical Systems, member of Getinge. They gave lectures for Baxter and for Masimo.

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Authors and Affiliations

  1. Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de recherche clinique CARMAS, Le Kremlin-Bicêtre, France

    Xavier Monnet & Jean-Louis Teboul

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  1. Xavier Monnet
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  2. Jean-Louis Teboul
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Correspondence to Xavier Monnet .

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Editors and Affiliations

  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

  2. UC San Diego, Department of Medicine, La Jolla, CA, USA

    Atul Malhotra

  3. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Kathryn A. Hibbert

  4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Charles Corey Hardin

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Monnet, X., Teboul, JL. (2021). Measurements of Fluid Requirements with Cardiovascular Challenges. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_27

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  • DOI: https://doi.org/10.1007/978-3-030-73387-2_27

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