15.05.2024 | Editorial
Using echocardiography to predict fluid-responsiveness and manage the need for fluids
verfasst von:
Antoine Vieillard-Baron, Florence Boissier, Michel Slama
Erschienen in:
Intensive Care Medicine
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Excerpt
Management of fluids has progressively moved toward a more dynamic and functional approach based on the prediction of fluid responsiveness (FR), to improve efficacy and benefits and limit detrimental effects of fluids [
1]. Application of an optimal threshold for validated parameters above which the patient could be fluid-responsive generates a “gray zone” [
2]. Therefore, the objective of intensivists should be to adapt the threshold to the respective sensitivity and specificity they need to predict FR, according to the patient’s condition. Intensivists should consider being very specific in severely hypoxemic patients where fluids can be significantly harmful and mainly sensitive in patients without blood gas abnormalities, as maintaining non-optimal volume could be detrimental here. Applying a continuous approach to the prediction of FR, i.e., how much the cardiac output is expected to increase after fluid bolus, rather than the classic binary one, i.e., will the patient be a “responder”, could be more efficient [
3]. …