* Critical Care Pearls: Dynamic Measures of Intravascular Volume Assessment in Critically Ill Patients - The resuscitation of a patient in shock often requires the administration of intravenous fluid. Excessive fluid resuscitation can lead to worsening pulmonary edema, systemic edema, acid-base disturbances, as well as many other complications. - There are a myriad of techniques to try and figure out if the patient needs more intravascular volume, but each has it’s pitfalls. - Recently, experts have recommend that we move away from using static measures of preload assessment such as central venous pressure (CVP) and instead focus on using dynamic measures for volume responsiveness. - “Volume Responsiveness” is defined as: an increase of stroke volume of 10-15% after a 500 mL IV crystalloid bolus over 10-15 minutes. - Attached is a chart describing key values, requirements, and contraindications for each of these dynamic measures of non-invasive intravascular volume assessment. - Important notes: • PPV and SVV require the patient to be intubated with controlled tidal volumes. Arrhythmias and right heart failure make many of these measures invalid (except for PLR). • Other methods of assessment not discussed include systolic pressure variation, left ventricular outflow track velocity time integral (LVOT VTI), and end-expiratory occlusion pressure (EEO). - Bottom Line: • None of these measures are perfect and shouldnt be used in isolation to determine if the patient’s “tank is full”. • Combine clinical judgment with these measures to get a best estimate of whether or not to give that next fluid bolus. * Reference: 1. Enomoto TM, Harder L. Dynamic indices of preload. Crit Care Clin. 2010;26(2):307-21,
Posted on: Wed, 03 Dec 2014 04:47:04 +0000
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