Anest. intenziv. Med. 2014;25(2):107-116

Static and dynamic tests for management of volumotherapyIntesive Care Medicine - Review Article

Káňová Marcela^1,*, Ševčík Pavel^1,2

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny FN Ostrava

² Katedra intenzivní medicíny a forenzních oborů, Lékařská fakulta Ostravské univerzity

The clinical determination of the intravascular volume can be extremely difficult in critically ill patients. Fluid therapy is the first step in the resuscitation of hemodynamically unstable patients. Both underresuscitation and overresuscitation are associated with increased morbidity and mortality. The resuscitation of the critically ill patient therefore requires an accurate assessment of the patients' intravascular volume status (cardiac preload) and the ability to predict the hemodynamic response after a fluid challenge (volume responsiveness). Only about half of the critically ill patients exhibit volume responsiveness - defined as the ability to increase stroke volume in response to fluid challenge. Traditional methods of determining preload (static parameters as cardiac filling pressures including the central venous pressure and the pulmonary artery occlusion pressure) have been used to guide fluid management. But now it is known, they are inaccurate and unable to predict fluid responsiveness. Dynamic parameters based on respiratory variations in venous return and subsequently stroke volume, use heart-lung interaction during mechanical ventilation to assess fluid responsiveness and are highly predictive. Especially the pulse pressure variation, stroke volume variation and the systolic pressure variation have high sensitivity and specificity in optimization of preload.

Keywords: intravascular volume status; preload; volume responsiveness; static parameters; dynamic parameters; heart-lung interaction

Received: December 18, 2013; Accepted: February 23, 2014; Published: April 1, 2014  Show citation