Prediction of fluid responsiveness: a review

Abstract

Methods for prediction of fluid responsiveness are needed during shock resuscitation. Fluid therapy remains a cornerstone in the treatment of shock and influences the outcomes directly. Excess or insufficient fluid administration is associated with increased morbidity and mortality. Prediction of fluid responsiveness means that a hemodynamic variable is used to determine how likely a patient is to respond to fluid bolus with a significant increase in their cardiac output. Depending on the response to fluids, patients are either responders or non-responders. Clinicians often rely on static indices of preload, like central venous pressure and pulmonary artery occlusion pressure, as a guide for fluid therapy. Unfortunately, whilst easy for use, these indices are of minimal value as predictors of fluid responsiveness. More recent research highlights hemodynamic variables related to cardiopulmonary interactions during mechanical ventilation. These dynamic indices, viz. stroke volume variation and pulse pressure variation, show a significantly better predictive value. To maximize the predictive value of dynamic indices, several conditions must be fulfilled. Another method for prediction of fluid responsiveness is represented by the functional hemodynamic tests: a heterogenous group of bedside tests for preload responsiveness. Fluid challenges remain popular, although repetitive use can be harmful. Hemodynamic tests, like passive leg raising or end-expiratory occlusion, modify the preload without fluid administration. Regardless of the test used, monitoring of cardiac output is needed to evaluate the heart’s response to changes in preload. This review gives an overview of the methods for fluid responsiveness prediction, including those explored in the COVID-19 context.

Keywords

• fluid responsiveness
• central venous pressure
• pulse pressure variation
• fluid challenge
• passive leg raise