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• W2891716182 abstract "In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiacoutput as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other ―static‖markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditionaluse should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are basedon the principle of inducing short term changes in cardiac preload, using heart–lung interactions, the passive leg raise orby the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure andstroke volume variations were first developed, but they are reliable only under strict conditions. The variations in venacaval diameters share many limitations of pulse pressure variations. The passive legraising test is now supported bysolid evi dence and is more frequently used. More recently, the endexpiratory occlusion test has been described, whichis easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluidoverload. The dynamic tests are complementary, and clinicians should choose between them based on the status of thepatient and the cardiac output monitoring technique. Several methods and tests are currently available to identifypreload responsiveness. All have some limitations, but they are frequently complementary. Along with elementsindicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in areasoned way." @default.
• W2891716182 created "2018-09-27" @default.
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• W2891716182 date "2018-03-01" @default.
• W2891716182 modified "2023-10-16" @default.
• W2891716182 title "FLUID CHALLENGES IN INTENSIVE CARE: MONITORING FLUID RESPONSIVENESS IN CRITICALLY ILL PATIENTS" @default.
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• W2891716182 doi "https://doi.org/10.21608/zumj.2018.13083" @default.
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