title: Hemodynamic assessment in the critically ill patient.
abstract: A growing fraction of the clinical duties of Nephrologists is undertaken inside intensive care units. While assessing patients with acute renal failure in the context of circulatory collapse, which are also edematous and/or with impaired gas exchanges, the Nephrologist must decide between two opposing therapies: 1) remove volume with the aid of dialysis or diuretics to improve the edematous state; 2) volume expand to improve hemodynamics. To minimize the odds of making incorrect choices, the Nephrologist must be familiar with the tools available for determining the adequacy of volume status and for invasive hemodynamic monitoring in the critically ill patient. In this manuscript, we will briefly review the physiology of extra cellular fluid volume regulation and then tackle the issue of volume status assessment, based on clinical and hemodynamic criteria.
authors.affiliation: Medicine Department of Faculdade de Medicina da Bahia – Universidade Federal da Bahia, Salvador – BA – Brazil. paulonrocha@ufba.br
authors.forename: Paulo Novis
authors.initials: PN
authors.lastname: Rocha
authors.forename: Jorge Arnaldo Valente
authors.initials: JA
authors.lastname: de Menezes
authors.forename: José Hermógenes Rocco
authors.initials: JH
authors.lastname: Suassuna
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D001794:Blood Pressure; D001811:Blood Volume Determination; D016638:Critical Illness; D003935:Diagnostic Techniques, Cardiovascular; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units