title: Direct markers of organ perfusion to guide fluid therapy: when to start, when to stop.
abstract: Up until now, the discussion in the literature as to the choice of fluids is almost completely restricted to the composition, with little to no attention paid to the importance of hemodynamic end points to achieve a desired optimal volume. The determination of fluid volume is left to the discretion of the attending physician with only surrogate markers as guidance the initiation and cessation of fluid therapy. In this article, we aim to discuss the available literature on existing clinical and experimental criteria for the initiation and cessation of fluid therapy. Furthermore, we present recent data that have become available after the introduction of direct in vivo microscopy of the microcirculation at the bedside, and discuss its potential influence on the existing paradigms and controversies in fluid therapy.
authors.affiliation: Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Mailbox 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: gerke52@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Veenstra
authors.affiliation: Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Mailbox 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: c.ince@erasmusmc.nl.
authors.forename: C
authors.initials: C
authors.lastname: Ince
authors.affiliation: Medical Centre Leeuwarden ICU, Henri Dunantweg 2, Mailbox 888, 8901 BR Leeuwarden, The Netherlands. Electronic address: e.boerma@chello.nl.
authors.forename: E C
authors.initials: EC
authors.lastname: Boerma
mesh_terms: D000818:Animals; D001811:Blood Volume Determination / Q000379:methods / Q000592:standards; D005440:Fluid Therapy / Q000379:methods / Q000592:standards*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology*; D017410:Practice Guidelines as Topic / Q000592:standards*; D014018:Tissue Distribution / Q000187:drug effects / Q000502:physiology
keywords: capillary density; fluid therapy; microcirculation; microcirculatory blood flow; organ perfusion; resuscitation end points