Fluid Challenge Revisited Bin Du, MD Medical ICU, Peking Union Medical College Hospital Why Fluid Challenge acutely ill patients frequently require fluid repletion hypovolemia external loss: bleeding, gastrointestinal, urinary tracts, skin internal loss: extravasation of blood, exudation/transudation of fluids Relative hypovolemia: increases venous capacitance sepsis, drugs volume repletion essential restore critical levels of cardiac output and arterial pressure, more normal perfusion of vital organs and tissues Why Fluid Challenge Why Fluid Challenge Clinical examination: limited sensitivity & specificity history physical signs routine laboratory tests Any given level of filling pressure ↓→more likely hypovolemia ↑→more likely right / left heart failure neither sufficiently reliable CVP & PAOP Fluid Challenge: When Fluid Challenge: When Functional Hemodynamics Systolic pressure variation (SPV) Stroke volume variation (SVV) Pulse pressure variation (PPV) Respiratory systolic variation test (RSVT) Respiratory-induced IVC diameter change reliably measured only during CMV tidal volume dependent unreliably measured during arrhythmia affected by decreased chest wall compliance misleading during right heart failure Who Need Fluid Challenge Fluid Challenge: What Fluid Fluid Challenge: What Fluid Fluid Challenge: What Fluid Fluid Challenge: What Fluid conclusion pulmonary edema and LIS not affected by the type of fluid loading in the steep part of the cardiac function curve in septic and nonseptic patients pulmonary capillary permeability as a smaller determinant of pulmonary edema than COP and CVP Fluid Challenge: How Much The amount of fluid to be administered over a defined interval Fluid Challenge: How Much Fluid Challenge: How Much Original technique 600 - 1000 ml / hr Other studies (mostly from Teboul JL et al about PLR) 500 ml / 10 - 30 min Surviving Sepsis Campaign Guideline Crystalloid 500 - 1000 ml / 30 min Colloid 300 - 500 ml / 30 min Fluid Challenge: Where
