Tuesday, February 28, 2017

Fluid Responsiveness

R.E.B.E.L.EM - February 27, 2017 - By Christina Chien
Post Peer Reviewed By: Salim Rezaie
"Clinical Take Home Points:
  • Fluid resuscitation is an essential skill in EM and critical care but is poorly understood.
  • Fluid administration should be guided both by the concepts of fluid responsiveness (dictated by the Frank-Starling curve) and fluid tolerance.
  • Because it is difficult to know which patients with sepsis will be fluid responsive, small, frequent boluses may be preferred, and early vasopressor use should be considered.
  • This may difficult to apply in EM as we do not have technologically advanced cardiac output monitoring devices. However, the principles of fluid resuscitation are sound, and should make us think critically on how to manage these patients.
“…in almost half of the patients no hemodynamic variable was used to predict fluid responsiveness – and if used, CVP was used most often.” (Cecconi 2015). Only about 50% of hemodynamically unstable patients are fluid responsive, and only about 50% of those patients are tested for fluid responsiveness; this is a major aspect of emergency and critical care medicine that we can focus on improving."