Data availability and feasibility of various techniques to predict response to volume expansion in critically ill patients

Abstract

Objective:The accuracy of various techniques to predict response to volume expansion in shock has been studied, but less well known is how feasible these techniques are in the ICU.Methods:This is a prospective observation single-center study of inpatients from a mixed profile ICU who received volume expansion. At time of volume expansion, we determined whether a particular technique to predict response was feasible, according to rules developed from available literature and nurse assessment.Results:We studied 214 volume expansions in 97 patients. The most feasible technique was central venous pressure (50%), followed by vena cava collapsibility, (47%) passive leg raise (42%), and stroke volume variation (22%). Aortic velocity variation, and pulse pressure variation, and were rarely feasible (1% each). In 37% of volume expansions, no technique that we assessed was feasible.Conclusions:Techniques to predict response to volume expansion are infeasible in many patients in shock.

The cardiovascular effects of crystalloid administration in endoscopy patients

“…[10][11][12]18 Recent Intensive Care Unit data suggests that up to 40% of patients have clinical conditions making no currently utilised fluid responsiveness measures useful. 19 Some preliminary data does suggest that SV variation may have some utility in spontaneously ventilating patients. 20,21 In the practice of our institution, most patients having colonoscopy routinely receive 10 ml/ kg of crystalloid up to 1000 ml.…”

“…10–12,18 Recent Intensive Care Unit data suggests that up to 40% of patients have clinical conditions making no currently utilised fluid responsiveness measures useful. 19…”

What′s New in Critical Illness and Injury Science? The continued search for the ideal hemodynamic monitoring device: Spending ourselves in a worthy cause and coming up short

“…[ 1 ] and Lanspa et al . [ 2 ] address the important topics of predicting hemodynamic states/responses through monitoring devices in the perioperative period of cardiac surgery patients and volume expansion in critically ill patients in a shock state, respectively.…”