Fluid Responsiveness & Tolerance

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Abstract

Fluids are beneficial when needed but harmful in excess. Determining when to give fluids is a foundational critical care skill. This ICU OnePager reviews how to measure CO including invasive techniques (pulse pressure variation, pulse contour analysis, pulmonary artery catheters), ultrasound techniques (LVOT and carotid VTI, IVC distensibility) and less invasive technqiues (NICOM, End-Tidal CO2, etc). It also discusses the maneuvers that we can perform to test for fluid responsiveness: Passive Leg Raise (PLR), Mini-bolus, PEEP challenge, and End-Expiratory Occlusion (EEO). As a bonus, we talk about emerging techniques (fluid tolerance testing, VEXUS) as well as some techniques that just refuse to die (CVP, IVC size, PCWP, etc)