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Prediction of Fluid Responsiveness in Patients With Shock

Monnet, Xavier MD, PhD*,†; Teboul, Jean-Louis MD, PhD*,†

doi: 10.1097/CPM.0000000000000066
Critical Care/Respiratory Care

In a patient with hemodynamic failure, volume expansion is used to increase cardiac output, thereby improving tissue oxygenation. Nevertheless, the relationship between cardiac output and preload is curvilinear, and so the expected increase in cardiac output frequently does not occur. This supports the concept of predicting fluid responsiveness. In addition, evidence is growing that administration of too much fluid to critically ill patients impairs organ function and increases mortality. Thus, it is crucial to avoid potentially harmful volume expansion if it does not improve cardiac output. This supports the concept of predicting fluid unresponsiveness. There is today solid evidence that fluid responsiveness/unresponsiveness cannot be predicted by static markers of cardiac preload, like central venous pressure. In contrast, a dynamic approach to prediction has increasingly proven valid and useful. We review methods at the bedside currently used to predict fluid responsiveness/unresponsiveness before deciding whether or not to administer fluid. The method that was initially described consists in observing changes in stroke volume resulting from heart-lung interactions during invasive mechanical ventilation. Some alternatives were developed later, like passive leg raising and the end-expiratory occlusion test. In light of the latest literature, we describe their practical aspects, value, and limitations.

*AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de Réanimation Médicale

Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France

Disclosure: X.M. and J.-L.T. are members of the Medical Advisory Board of Pulsion Medical Systems.

Address correspondence to: Xavier Monnet, MD, PhD, Service de Réanimation Médicale, Hôpital de Bicêtre, 78, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.