Abstract
Although fluid resuscitation of patients having acute circulatory failure is essential, avoiding unnecessary administration of fluids in these patients is also important. Fluid responsiveness (FR) is defined as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration. The objective of this review is to provide the recent advances in the detection of FR and simplify the physiological basis, advantages, disadvantages, and cut-off values for each method. This review also highlights the present gaps in literature and provides future thoughts in the field of FR.Static methods are generally not recommended for the assessment of FR. Dynamic methods for the assessment of FR depend on heart-lung interactions. Pulse pressure variation (PPV) and stroke volume variation (SVV) are the most famous dynamic measures. Less-invasive dynamic parameters include plethysmographic-derived parameters, variation in blood flow in large arteries, and variation in the diameters of central veins. Dynamic methods for the assessment of FR have many limitations; the most important limitation is spontaneous breathing activity.Fluid challenge techniques were able to overcome most of the limitations of the dynamic methods. Passive leg raising is the most popular fluid challenge method. More simple techniques have been recently introduced such as the mini-fluid challenge and 10-s fluid challenge. The main limitation of fluid challenge techniques is the need to trace the effect of the fluid challenges on SV (or any of its derivatives) using a real-time monitor. More research is needed in the field of FR taking into consideration not only the accuracy of the method but also the ease of implementation, the applicability on a wider range of patients, the time needed to apply each method, and the feasibility of its application by acute care physicians with moderate and low experience.
Highlights
Fluid resuscitation is the cornerstone of managing patients having acute circulatory failure
The objective of this review is to provide the recent advances in the detection of Fluid responsiveness (FR) and simplify the physiological basis, advantages, disadvantages, and cut-off values for each method
The combination of Internal jugular vein (IJV) distensibility of 9.7 % and Pulse pressure variation (PPV) more than 12 % reaches a sensitivity of 100 % and Aortic velocity variation Respiratory variation of peak aortic velocity was reported as a good indicator for FR in critically ill patients under mechanical ventilation: the best cut-off value was 18 % when measured by esophageal Doppler [48] and 12 % when measured by trans-esophageal echocardiography [49]
Summary
Fluid resuscitation is the cornerstone of managing patients having acute circulatory failure. Plethysmographic dynamic indices Pulse oximetry plethysmographic waveform amplitude (POP) is measured using a special pulse oximetry sensor; plethysmographic variability index (PVI) is more measured using Masimo device Both POP and PVI were reported in a recent meta-analysis as good indicators for FR in mechanically ventilated patients without cardiac arrhythmias, heart failure, or spontaneous activity with cut-off value 9.1–15 % [36]. Failure of dynamic methods in detecting FR was reported in patients with spontaneous breathing [52, 53] as well as patients on pressure support ventilation [54] This was explained by the dependence of dynamic parameters on regular variations in intrathoracic pressure, tidal volume, and rate; all these components are highly variable in spontaneous breathing patients in addition to the effect of abdominal muscle contractions (which is common with spontaneous breathing efforts) on the preload response [55]. This was explained by the fact that low tidal volume induces small variation in thoracic pressure and
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