Assessment of indices of preload and volume responsiveness.
OBJECTIVE
To summarize the relevant peer-reviewed publications over the past year that addressed issues of when to give (or not give) fluid to the critically ill patient.


RESULTS
Clinical data from several studies underscore the inability of measures of ventricular filling to assess either preload or preload responsiveness. Whereas less invasive monitoring techniques than pulmonary arterial catheterization demonstrate better discrimination with estimates of both preload and preload responsiveness. Measuring dynamic changes in stroke volume, descending aortic flow, and both superior and inferior vena caval diameters during ventilation provides good predictive value in defining preload responsiveness. One study demonstrated that resuscitation protocols keyed to esophageal flow measures improved outcome in postoperative cardiac surgery patients.


CONCLUSIONS
Preload is not preload responsiveness. Functional measures of preload responsiveness exist and are superior to traditional measures of filling pressures in driving resuscitation in critically ill patients.
Pinsky
Michael R
MR
Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania 15261, USA. pinskymr@ccm.upmc.edu
Teboul
Jean-Louise
JL
D002407:Catheterization, Swan-Ganz; D002986:Clinical Trials as Topic; D016638:Critical Illness; D017548:Echocardiography, Transesophageal; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D013318:Stroke Volume; D016276:Ventricular Function