Where Are We Heading With Fluid Responsiveness and Septic Shock?

Abstract

When hypovolemia is left uncorrected, it can lead to poor tissue oxygenation and organ dysfunction. On the other hand, excessive fluid administration can increase the risk of complications. Assessing volume responsiveness in critically ill patients is therefore crucial. In this article we summarized the literature addressing the most sensitive and specific dynamic predictors for fluid responsiveness, to help clarify the best way to guide clinicians in managing patients with shock. Data were collected from PubMed and EMBASE of high-quality articles, randomized controlled trials (RCTs), retrospective research, and metanalyses; articles were identified from January 2000 to February 2021. We identified and critically reviewed the published peer-reviewed literature investigating the dynamic predictors to assess fluid responsiveness. Evidence suggests that the traditional use of static predictors for fluid responsiveness should be abandoned. Over the last 20 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload using heart-lung interactions. However, in routine practice the conditions to meet the requirements of these dynamic parameters are frequently not met. Therefore, more dynamic predictors that do not depend on heart-lung interaction have developed such as the mini fluid challenge test and passive leg raising test These tests have fewer limitations and higher sensitivity and specificity compared to the other tests.