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Erschienen in: Critical Care 4/2009

01.08.2009 | Commentary

Detecting volume responsiveness and unresponsiveness in intensive care unit patients: two different problems, only one solution

verfasst von: Jean-Louis Teboul, Xavier Monnet

Erschienen in: Critical Care | Ausgabe 4/2009

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Abstract

Policies of fluid administration/restriction in critically ill patients have evolved over recent years. Abundant fluid resuscitation is encouraged during the early stage of severe sepsis. But a conservative fluid strategy is recommended in later stages, in particular when lungs are injured. Both strategies are risky if uncontrolled. Tests detecting volume unresponsiveness at any moment of fluid resuscitation or detecting volume unresponsiveness at any moment of fluid restriction would help to better assess the benefit/risk ratio of continuing such strategies. Measuring the short-term hemodynamic changes during passive leg raising can be reliably used for that purpose in both situations, even when patients are breathing spontaneously.
Literatur
1.
Zurück zum Zitat Thiel SW, Kollef MH, Isakow W: Non-invasive volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study. Crit Care 2009, 13: R111. 10.1186/cc7955PubMedCentralCrossRefPubMed Thiel SW, Kollef MH, Isakow W: Non-invasive volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study. Crit Care 2009, 13: R111. 10.1186/cc7955PubMedCentralCrossRefPubMed
2.
Zurück zum Zitat Monnet X, Teboul JL: Passive leg raising. Intensive Care Med 2008, 34: 659-663. 10.1007/s00134-008-0994-yCrossRefPubMed Monnet X, Teboul JL: Passive leg raising. Intensive Care Med 2008, 34: 659-663. 10.1007/s00134-008-0994-yCrossRefPubMed
3.
Zurück zum Zitat Michard F, Teboul JL: Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 2000, 4: 282-289. 10.1186/cc710PubMedCentralCrossRefPubMed Michard F, Teboul JL: Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 2000, 4: 282-289. 10.1186/cc710PubMedCentralCrossRefPubMed
4.
Zurück zum Zitat Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000CrossRefPubMed Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000CrossRefPubMed
5.
Zurück zum Zitat Marik PE, Cavallazzi R, Vasu T, Hirani A: Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009, in press. Marik PE, Cavallazzi R, Vasu T, Hirani A: Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009, in press.
6.
Zurück zum Zitat Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL: Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006, 34: 1402-1407. 10.1097/01.CCM.0000215453.11735.06CrossRefPubMed Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL: Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006, 34: 1402-1407. 10.1097/01.CCM.0000215453.11735.06CrossRefPubMed
7.
Zurück zum Zitat Heenen S, De Backer D, Vincent JL: How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care 2006, 10: R102. 10.1186/cc4970PubMedCentralCrossRefPubMed Heenen S, De Backer D, Vincent JL: How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care 2006, 10: R102. 10.1186/cc4970PubMedCentralCrossRefPubMed
8.
Zurück zum Zitat De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL: Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005, 31: 517-523. 10.1007/s00134-005-2586-4CrossRefPubMed De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL: Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005, 31: 517-523. 10.1007/s00134-005-2586-4CrossRefPubMed
9.
Zurück zum Zitat Vincent JL, Weil MH: Fluid challenge revisited. Crit Care Med 2006, 34: 1333-1337. 10.1097/01.CCM.0000214677.76535.A5CrossRefPubMed Vincent JL, Weil MH: Fluid challenge revisited. Crit Care Med 2006, 34: 1333-1337. 10.1097/01.CCM.0000214677.76535.A5CrossRefPubMed
10.
Zurück zum Zitat Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL: Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 2007, 33: 1125-1132. 10.1007/s00134-007-0646-7CrossRefPubMed Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL: Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 2007, 33: 1125-1132. 10.1007/s00134-007-0646-7CrossRefPubMed
11.
Zurück zum Zitat Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007, 35: 64-68. 10.1097/01.CCM.0000249851.94101.4FCrossRefPubMed Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007, 35: 64-68. 10.1097/01.CCM.0000249851.94101.4FCrossRefPubMed
12.
Zurück zum Zitat Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed
13.
Zurück zum Zitat Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601CrossRefPubMed Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601CrossRefPubMed
14.
Zurück zum Zitat Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed
15.
Zurück zum Zitat Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D: Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3ACrossRefPubMed Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D: Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3ACrossRefPubMed
16.
Zurück zum Zitat Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL: Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008, 12: R74. 10.1186/cc6916PubMedCentralCrossRefPubMed Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL: Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008, 12: R74. 10.1186/cc6916PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41CrossRefPubMed Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41CrossRefPubMed
18.
Zurück zum Zitat Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL: Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006, 354: 2564-2575. 10.1056/NEJMoa062200CrossRefPubMed Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL: Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006, 354: 2564-2575. 10.1056/NEJMoa062200CrossRefPubMed
Metadaten
Titel
Detecting volume responsiveness and unresponsiveness in intensive care unit patients: two different problems, only one solution
verfasst von
Jean-Louis Teboul
Xavier Monnet
Publikationsdatum
01.08.2009
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 4/2009
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7979

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