Volume Responsiveness: What It Does Not Tell Us

Manecke, Gerard R.

doi:10.1053/j.jvca.2020.12.038

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Ostensibly, this occurs in a patient with a normal heart, who is ‘over-resuscitated’ by IV fluids. Arriving at this state is a criticism leveled against protocols that administer preload until fluid responsiveness disappears; there is data to support this concern [ 87 ]. For example, some algorithms for goal-directed therapy during elective surgery ‘optimize’ preload by encouraging IV fluid until fluid responsiveness is extinguished.…”

Section: Physiological Frameworkmentioning

confidence: 99%

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Kenny

2022

Medical Sciences

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Ultrasonography is becoming the favored hemodynamic monitoring utensil of emergentologists, anesthesiologists and intensivists. While the roles of ultrasound grow and evolve, many clinical applications of ultrasound stem from qualitative, image-based protocols, especially for diagnosing and managing circulatory failure. Often, these algorithms imply or suggest treatment. For example, intravenous fluids are opted for or against based upon ultrasonographic signs of preload and estimation of the left ventricular ejection fraction. Though appealing, image-based algorithms skirt some foundational tenets of cardiac physiology; namely, (1) the relationship between cardiac filling and stroke volume varies considerably in the critically ill, (2) the correlation between cardiac filling and total vascular volume is poor and (3) the ejection fraction is not purely an appraisal of cardiac function but rather a measure of coupling between the ventricle and the arterial load. Therefore, management decisions could be enhanced by quantitative approaches, enabled by Doppler ultrasonography. Both fluid ‘responsiveness’ and ‘tolerance’ are evaluated by Doppler ultrasound, but the physiological relationship between these constructs is nebulous. Accordingly, it is argued that the link between them is founded upon the Frank–Starling–Sarnoff relationship and that this framework helps direct future ultrasound protocols, explains seemingly discordant findings and steers new routes of enquiry.

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Section: Physiological Frameworkmentioning

confidence: 99%

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Kenny

2022

Medical Sciences

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Infusion therapy in critical patients (state of problem). Part 2

Zhezhuk,

Vlasenko,

Evdokimov

et al. 2024

Medicinskij alfavit

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With the development of clinical pathophysiology, the basic concepts of maintaining fluid homeostasis of the body in normal and critical conditions were revised, and the negative effects of infusion therapy at all stages of its use were studied. Therefore, in the intensive care of shock, the main clinical questions are: when to start fluid therapy, when to stop active fluid therapy, when to start fluid removal from the body, and when to stop fluid de-resuscitation. Thus, in order to implement the principle of personalized treatment, it is important to determine not only the ‘tolerance’ of infusion therapy, but also the ‘sensitivity’ to the infusion of a particular patient – the ability to maintain hemodynamics without the risk of fluid overload. Evaluation of routine clinical, instrumental and laboratory indicators of the state of macro- and microcirculation does not provide an opportunity to accurately answer these questions. Modern sonographic methods for monitoring central and peripheral cardiohemodynamics, ‘venous excess’ using Doppler and extended focus echocardiography allow us to assess the ‘tolerance of infusion therapy’. The implementation of this new direction will increase the efficiency and safety of infusion therapy and improve the outcomes of the critically ill patients’ treatment.

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Volume Responsiveness: What It Does Not Tell Us

Cited by 2 publications

References 10 publications

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Infusion therapy in critical patients (state of problem). Part 2

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