An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Fluid responsiveness is defined as "as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration". There are multiple strategies to define fluid responsiveness in patients who are on mechanical ventilation such as PPV, SVV, EEOP. Positive end-expiratory pressure (PEEP) can decrease cardiac output in mechanically ventilated patients. …
Continue reading PEEP-Test for Fluid/Volume Responsiveness in Resuscitation
There are numerous methodologies that we can utilize to determine fluid responsiveness in our critically ill patients in the emergency department or in the intensive care unit. In this post, I will be taking a deep dive into pulse pressure variation, PPV as the shorthand. For details about the other methods for determining fluid responsiveness, …
Continue reading Pulse Pressure Variation (PPV) for Fluid/Volume Responsiveness
What is end-expiratory occlusion testing? It is a method we can use at the bedside to determine whether a patient is fluid-responsive. We have actually known about this since 2009 when Monnet et al. explored this concept in a not-free article. The full description of the heart-lung interaction that allows this to work is beyond …
Continue reading End-Expiratory Occlusion for Fluid/Volume Responsiveness
This is a work-in-progress blog post for my lecture "Resuscitation and Fluid Responsiveness." In the lecture, I discuss fluid resuscitation in sepsis and volume responsiveness. After all, only 50% of critically ill patients are fluid responsive, and 66% of patients in septic shock are volume overloaded on hospital day 1 (Douglas et al.). Those are …
Continue reading Resuscitation in Sepsis using Fluid/Volume Responsiveness
I have covered many things on this page, including resuscitation and fluid responsiveness. Fluid responsiveness is a patient being given a certain amount of fluid, or a passive leg raise to assess how that will increase the cardiac output/index or stroke volume. This post will discuss stroke volume variation (SVV) and how it predicts fluid …
Dinosaurs still roam the earth, I know this. They are slowly and surely retiring, though. I trained in the days where Manny Rivers and the Surviving Sepsis Campaigns pushed for Early-Goal Directed Therapy were king. Hey, there was a reason why it was so successful, EGDT decreased in-hospital mortality from 46.5% to 30.5% in that …
You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Here, I explain what they are. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're …
Continue reading SvO2 and ScvO2 to Guide Resuscitation in Septic & Cardiogenic Shock
This post is regarding using passive leg raising and stroke volume to determine fluid responsiveness in patients who need resuscitation. Check out far more in depth data regarding all this HERE. Don't think that I'm anywhere close to being finished on discussing fluid resuscitation and when to stop, I think I could spend a whole …
Continue reading Passive Leg Raising + Stroke Volume for Fluid/Volume Responsiveness
Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful This is where I stand on the matter today, November 3rd, 2020. I am open to changing my mind with new data. Guiding fluid responsiveness, as I’ve covered here, is a huge pain in the butt. But giving …
Continue reading Inferior Vena Cava (IVC) POCUS for Resuscitation
To my knowledge, this is the second article looking at central venous pressure (CVP). It was published back in 1962. This paper piggybacks off of, what I believe to be the first paper on CVP that I covered here. Ultimately, I read all these papers as I was creating a lecture that is titled "Resuscitation …
Continue reading Central Venous Pressure (CVP): Known Limitations in 1962