Stroke Volume Optimization Versus Central Venous Pressure in Fluid Management

Ahrens, Tom

doi:10.4037/ccn2010954

Cited by 1 publication

(2 citation statements)

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“…Cardiac pressures help provide estimates of blood volume; however, normal cardiac pressures can be observed in a patient in shock and provide little information about blood flow. 30,[95][96][97] Interpretation and treatment of blood pressures incorporate assumptions, whereas stroke volume may be considered a more precise measure of fluid responsiveness and an earlier warning sign of volume depletion than are urine output, altered mental status, CVP, heart rate, and blood pressure. [1][2][3][4][5] Earlier signals allow clinicians to anticipate rather than react to changes, improving the likelihood for maintaining a stable metabolic state at the organ and cellular level.…”

Section: Discussionmentioning

confidence: 99%

“…Even though guidelines such as those of the Surviving Sepsis Campaign 29 recommend using CVP to monitor preload, no study of CVP or pulmonary artery occlusive pressure (PAOP) has shown that these pressures consistently correlate with blood flow or volume status. 30 Early and aggressive use of fluid replacement to preestablished end points such as ScvO 2 is more likely than the measurement of CVP itself to provide patients benefit. 31,32 The limitations of CVP are further pointed out in the landmark study on septic shock by Rivers et al 33 published in 2001.…”

Section: Reconsidering Fluid Replacement End Pointsmentioning

confidence: 99%

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Stroke Volume Optimization: The New Hemodynamic Algorithm

Johnson

Ahrens

2015

Critical Care Nurse

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Critical care practices have evolved to rely more on physical assessments for monitoring cardiac output and evaluating fluid volume status because these assessments are less invasive and more convenient to use than is a pulmonary artery catheter. Despite this trend, level of consciousness, central venous pressure, urine output, heart rate, and blood pressure remain assessments that are slow to be changed, potentially misleading, and often manifested as late indications of decreased cardiac output. The hemodynamic optimization strategy called stroke volume optimization might provide a proactive guide for clinicians to optimize a patient’s status before late indications of a worsening condition occur. The evidence supporting use of the stroke volume optimization algorithm to treat hypovolemia is increasing. Many of the cardiac output monitor technologies today measure stroke volume, as well as the parameters that comprise stroke volume: preload, afterload, and contractility.

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