Abstract
Introduction. We systematically evaluated the use of transthoracic echocardiography in the assessment of dynamic markers of preload to predict fluid responsiveness in the critically ill adult patient. Methods. Studies in the critically ill using transthoracic echocardiography (TTE) to predict a response in stroke volume or cardiac output to a fluid load were selected. Selection was limited to English language and adult patients. Studies on patients with an open thorax or abdomen were excluded. Results. The predictive power of diagnostic accuracy of inferior vena cava diameter and transaortic Doppler signal changes with the respiratory cycle or passive leg raising in mechanically ventilated patients was strong throughout the articles reviewed. Limitations of the technique relate to patient tolerance of the procedure, adequacy of acoustic windows, and operator skill. Conclusions. Transthoracic echocardiographic techniques accurately predict fluid responsiveness in critically ill patients. Discriminative power is not affected by the technique selected.
Highlights
We systematically evaluated the use of transthoracic echocardiography in the assessment of dynamic markers of preload to predict fluid responsiveness in the critically ill adult patient
It has been reported that as few as 40 percent of critically ill patients thought to be intravascularly deplete gain an improvement in cardiac output after a standard fluid bolus, exposing more than half of patients to the risks of excessive fluid administration [2]
This review shows that transthoracic echocardiography (TTE) is a highly discriminative test for the prediction of the stroke volume or cardiac output response to volume loading in critically ill patients, highlighting the potential for expansion of its role in quantitative assessment
Summary
We systematically evaluated the use of transthoracic echocardiography in the assessment of dynamic markers of preload to predict fluid responsiveness in the critically ill adult patient. Studies in the critically ill using transthoracic echocardiography (TTE) to predict a response in stroke volume or cardiac output to a fluid load were selected. Transthoracic echocardiographic techniques accurately predict fluid responsiveness in critically ill patients. Knowledge of static measures of preload such as central venous pressure, pulmonary artery wedge pressure, enddiastolic volumes, and intrathoracic blood volume has not translated into patient benefit [3,4,5,6] This suggests that measurement of preload does not foretell preload responsiveness
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