title: Vascular content, tone, integrity, and haemodynamics for guiding fluid therapy: a conceptual approach.
abstract: BACKGROUND
  Despite many clinical trials and investigative efforts to determine appropriate therapeutic intervention(s) for shock, this topic remains controversial. The use of i.v. fluid has represented the cornerstone for the treatment of hypoperfusion for two centuries.
  
  
  METHODS
  As a part of International Acute Dialysis Quality Initiative XII Fluids Workgroup meeting, we sought to incorporate recent advances in our understanding of vascular biology into a more comprehensive yet accessible approach to the patient with hypoperfusion. In this workgroup, we attempted to develop a framework that incorporates key aspects of the vasculature into a diagnostic approach.
  
  
  RESULTS
  The four main components of our proposal involve the assessment of the blood flow (BF), vascular content (vC), the vascular barrier (vB), and vascular tone (vT). Any significant perturbation in any of these domains can lead to hypoperfusion at both the macro- and micro-circulatory level. We have termed the BF, vC, vB, and vT diagnostic approach the vascular component (VC) approach.
  
  
  CONCLUSIONS
  The VC approach to hypoperfusion has potential advantages to the current diagnostic system. This approach also has the distinct advantage that it can be used to assess the systemic, regional, and micro-vasculature, thereby harmonizing the approach to clinical vascular diagnostics across these levels. The VC approach will need to be tested prospectively to determine if this system can in fact improve outcomes in patients who suffer from hypoperfusion.
authors.affiliation: Department of Medicine, Divisions of Intensive Care Medicine and Division of Nephrology, Washington DC Veteran Affairs Medical Center, Washington, DC, USA minkchawla@gmail.com.
authors.forename: L S
authors.initials: LS
authors.lastname: Chawla
authors.affiliation: Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Ince
authors.affiliation: Department of Anesthesiology, University Hospital of Munich, Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Chappell
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Gan
authors.affiliation: Center for Critical Care Nephrology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Center for Anaesthesia, University College London Hospitals, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Mythen
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Shaw
mesh_terms: D001808:Blood Vessels / Q000503:physiopathology*; D003697:Delphi Technique; D003956:Dialysis; D005440:Fluid Therapy / Q000379:methods* / Q000592:standards*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008833:Microcirculation; D010477:Perfusion; D012039:Regional Blood Flow / Q000502:physiology; D018805:Sepsis / Q000628:therapy
keywords: blood volume; cardiac output; fluid management; fluids; micro-circulation; resuscitation; vascular content; vascular integrity; vascular tone; volume