There is a good recent review on various methods to measure cardiac output to assess fluid responsiveness: Marik, PE. Noninvasive Cardiac Output Monitors: A State-of the-Art Review. J Cardiothorac Vasc Anesth. 2013 Feb;27(1):121-34. http://www.jcvaonline.com/article/S1053-0770%2812%2900148-6/fulltext
There is also good evidence that CVP does not predict fluid responsiveness well: Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8 http://journal.publications.chestnet.org/article.aspx?articleid=1085950 -Andy Andy Bourgeois, MD, FAAEM Simi Valley Hospital On Tue, Feb 12, 2013 at 6:17 AM, [email protected] < [email protected]> wrote: > > Fluid challenge is one of the most dificult things to do....sometimes you just need 1 l of cristaloids on others you will use as much as 5 l.....as it was mentioned above the clinical response is the goal....o others you will need more tools like central venous pressure, svo2 > Even measure the diameter of inferior cava vein all these to estimate where are you standing..... > Hope it helps > Juan pataro md > instituto argentino de riñon y transplante > > From my HTC Sensation 4G on T-Mobile. The first nationwide 4G network > > > ----- Reply message ----- > De: "Rich Levrault" <[email protected]> > Para: "sandeep varma" <[email protected]> > CC: "[email protected]" < [email protected]> > Asunto: [Sepsis Groups] volume required > Fecha: dom., feb. 10, 2013 10:59 a. m. > > > Fluid should be given until it fails to produce a clinically appropriate response. Pulmonary edema is sometimes a necessary evil. > > Sent from Rich's iPhone > > On Feb 9, 2013, at 1:15 AM, sandeep varma <[email protected]> wrote: > > hello all > i have a query regarding fluid volume requirement in sepsis. often have seen blood pressure improvement after fluid bolus but only to see it fall back after few minutes. the postulated theory behind this was leakage of given fluid into interstitial causing intravascular depletion again. my concern is that how much of fluid can be given this way? will this lead on to pulmonary edema and interstitial edema without much helping in building up intra vascular volume and aiding in stabilizing blood pressure? > sandeep varma > thriuvananthapuram > kerala > india > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org >
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