Volume responsive, but does the patient need volume?

Excerpt

Rapid administration of intravenous fluid or a “fluid challenge” is one of the most common interventions in the intensive care patient with manifest or perceived hemodynamic problems. The concept of fluid administration to evaluate cardiovascular function in shock was probably first introduced by Max Harry Weil more than 50 years ago [1] and has been referred to as fluid challenge in textbooks and papers since the mid-1970s [2]. The fluid challenge was described as a concept to evaluate the ability of the heart to handle the fluid load in the presence of clinical signs and symptoms of insufficient circulation. A fundamental principle of fluid challenge was defined by Weil in 1965: “The effect of fluid replacement on the clinical status of the patient in shock is gauged by objective changes in circulation, such as blood pressure, mental alertness, urine flow, peripheral venous filling, and appearance and texture of the skin” [1]. Impaired tissue perfusion was already then recognized as a key defect in acute circulatory failure. Subsequently, administration of large volumes of fluids became popular in the management of the widest spectrum of disorders in intensive care patients. Much of this evolution can be traced back to misinterpretations and oversimplification of basic physiology and pathophysiology—often accompanied by invasive hemodynamic monitoring with the pulmonary artery catheter. …