Fluid Optimization

Background

Fluid optimization for critically ill patients is an integral part of treatment in pre-operative, intra-operative, and post-operative settings. Central venous pressure (CVP) has traditionally been used as a rough surrogate for determining volume responsiveness. However, much literature has shown that CVP is in fact not a good indicator of volume responsiveness and therefore, not the best guide for conducting fluid resuscitation.

Continuous Hemodynamic monitoring provides an easy way to provide optimal fluid resuscitation and titration of medication to reduce morbidity, length of stay (LOS), and organ dysfunction.1,2 Number of studies show that goal-directed fluid administration results to better clinical outcomes.

Indicators of Volume Responsiveness

  • There are currently three widely accepted ways to gauge volume responsiveness along the Frank-Starling Curve shown on the figure above. Adequate fluid resuscitation is important in ED, ICU, and OR.
  • Passive Leg Raise (PLR) – A reversible dynamic fluid challenge test that only requires the raising of the patients legs to determine fluid responsiveness3
  • Corrected Flow Time (FTC) and Stroke Volume Variation (SVV) – may only be conducted in mechanically ventilated patients1,2
  • Fluid Bolus – Intravenous fluid bolus is given to observe the corresponding change in CO from baseline

Electrical Cardiometry™ (EC), a new, revolutionizing method of bioimpedance that provides an easy, cost-effective method of continuous measurement of hemodynamics including cardiac output. The EC monitors are an accurate, easy, and cost-effective method for providing optimal fluid resuscitation administration in completely non-invasive manner!

  1. Pinsky M, et al: Hemodynamic Evaluation and Monitoring in the ICU. Chest. 2007; 132:2020-2029
  2. Gan TJ, Soppitt A, Maroof M, et al: Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery. Anesthesiology 2002, 820-826
  3. Monnet X, et al: Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006 Vol. 34, No. 5. Pp 1402-1407.
  4. Xavier Monnet and Jean-Louis Teboul: Passive Leg Raising. Intensive care medicine, Vol. 34, No. 4. April 2008, pp. 659-663.
  5. Hollenberg Steven M: Inotrope and Vasopressor Therapy of Septic Shock. Crit Care Clin 25, 2009, pp. 781-802
  6. Rivers E, et al: Early Goal Directed therapy in the treatment of severe sepsis and septic shock
  7. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds M, Bennet D:Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. Critical Care 2005, R687-693M.