Intravascular volume status and volume responsiveness continue to be important questions for the management of critically ill or injured patients. Goal-directed hemodynamic therapy has been shown to be of benefit to patients with severe sepsis and septic shock, acute lung injury and adult respiratory distress syndrome, and for surgical patients in the operating room. Static measures of fluid status, central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) are not useful in predicting volume responsiveness. Stroke volume variation and pulse pressure variation related to changes in stroke volume during positive pressure ventilation predict fluid responsiveness and represent an evolving practice for volume management in the intensive care unit (ICU) or operating room. Adoption of dynamic parameters for volume management has been inconsistent. This manuscript reviews some of the basic physiology regarding the use of stroke volume variation to predict fluid responsiveness in the ICU and operating room. A management algorithm using this physiology is proposed for the critically ill or injured in various settings.
Michard F., Teboul JLPredicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121(6): 2000-2008.
2.
McGee WT , Steingrub JS, Callas P., Teres D.Severe sepsis in a community teaching hospital: 1983-85 and 1989-90. J Intensive Care Med. 1996;11(1):19-22.
3.
Rapoport J., Teres D., Steingrub J., Higgins T., McGee W., Lemeshow S.Patient characteristics and ICU organizational factors that influence frequency of pulmonary artery catheterization. JAMA. 2000;283(19):2559-2567.
4.
McGee WT , Steingrub JS, Callas PWFinancial impact of pulmonary artery catheterization in severe sepsis. Clin Intensive Care. 2000 ;11(3):137-143.
5.
Conners AF Jr , Speroff T., Dawson NV, et al., and the SUPPORT Investigators.The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996; 276(11):889-897.
6.
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(24):1717-1722.
7.
Gattinoni L. , Brazzi L., Pelosi P., et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med. 1995;333(16):1025-1032.
8.
Heyland DK, Cook DJ, King D., Kernerman P., Brun-Buisson C.Maximizing oxygen delivery in critically ill patients: a methodological appraisal of the evidence. Crit Care Med. 1996;24(3): 517-524.
9.
Diebel LN, Wilson RF, Tagett MG, Kline RAEnd-diastolic volume: a better indicator of preload in the critically ill . Arch Surg. 1992;127(7):817-822.
10.
Diebel L., Wilson RF, Heins J., Larky H., Warsow K., Wilson S.End-diastolic volume vs pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients. J Trauma. 1994 ;37(6):950-955.
11.
Tousignant CP, Walsh F., Mazer CDThe use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg. 2000;90(2):351-355.
12.
Feissel M., Michard F., Mangin I., Ruyer O., Faller JP, Teboul JLRespiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest. 2001;119(3):867-873.
13.
Thys DM, Hillel Z., Goldman ME, Mindich BP, Kaplan JAA comparison of hemodynamic indexes derived by invasive monitoring and two-dimensional echocardiography. Anesthesiology. 1987;67(5):630-634.
14.
Cheung AT, Savino JS, Weiss SJ, Aukburg SJ, Berlin JAEchocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology . 1994;81(2):376-387.
15.
Tavernier B. , Makhotine O., Lebuffe G., Dupont J., Scherpereel P.Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology. 1998;89(6): 1313-1321.
16.
Michard F., Boussat S., Chemla D., et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure . Am J Respir Crit Care Med. 2000;162(1):134-138.
17.
Perel A., Pizov R., Cotev S.Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology . 1987;67(4):498-502.
18.
Michard F., Teboul JLRespiratory changes in arterial pressure in mechanically ventilated patients . In: Vincent JL, ed. Yearbook of Intensive Care and Emergency Medicine. Berlin , Germany: Springer;2000:696-704.
19.
Jansen JRC , van den Berg PCMCardiac output by thermodilution and arterial pulse contour techniques. In: Pinsky MR , Payen D, eds. Update in Intensive Care and Emergency Medicine: Functional Hemodynamic Monitoring . Germany: Springer-Verlag Berlin Heidelberg; 2005:135-152.
20.
Michard F., Chemla D., Richard C., et al. Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med. 1999;159(3):935-939.
21.
Wise RA, Robotham JL, Summer WREffects of spontaneous ventilation on the circulation. Lung . 1981;159(4):175-186.
22.
McGregor M.Current concepts: pulsus paradoxus. N Engl J Med. 1979;301(9):480-482.
23.
Guyton AC, Hall JECardiac output, venous return, and their regulation. In: Textbook of Medical Physiology. 10th ed. Philadelphia, PA: WB Saunders Company ; 2000:210-222.
Pinsky MRCardiovascular issues in respiratory care. Chest. 2005;128(5 suppl 2):592S-597S.
26.
Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F.Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care. 2007;11(5):R100.
27.
McGee WT , Horswell JL, Hatib FS, et al. Relationship of SVV to SV: beyond Frank-Starling using arterial pressure-based technology . Crit Care Med. 2006;34(12 suppl):A60.
28.
Rhodes A., Sunderland R.Arterial pulse power analysis: the LiDCO™ plus system. In: Pinsky MR, Payen D, eds. Update in Intensive Care and Emergency Medicine: Functional Hemodynamic Monitoring. Germany: Springer-Verlag Berlin Heidelberg; 2005:183-192.
29.
Erlanger J. , Hooker DRAn experimental study of blood pressure and of pulse pressure in man. John Hopkins Hospital Records. 1904;15:145-378.
30.
IntelliVue MP90: Networked patient monitors with portal technology for highest intensity care.Philips Medical Systems Brochure; 2006. Accessed on September 30, 2008, from www.medical.philips.com
31.
Zollner C., Haller M., Weis M., et al. Beat-to-beat measurement of cardiac output by intravascular pulse contour analysis: a prospective criterion standard study in patients after cardiac surgery. J Cardiothorac Vasc Anesth. 2000;14(2):125-129.
32.
Felbinger TW , Reuter DA, Eltzschig HK, Moerstedt K., Goedje O., Goetz AEComparison of pulmonary arterial thermodilution and arterial pulse contour analysis: evaluation of a new algorithm. J Clin Anesth. 2002;14(4):296-301.
33.
Goedje O., Hoeke K., Goetz AE, et al. Reliability of a new algorithm for continuous cardiac output determination by pulse contour analysis during hemodynamic instability. Crit Care Med. 2002;30(1):52-29.
34.
Kurita T., Morita K., Kato S., Kikura M., Horie M., Ikeda K.Comparison of the accuracy of the lithium dilution technique with the thermodilution technique for measurement of cardiac output. Br J Anaesthesiol . 1997;79(6):770-775.
35.
Linton RA, Young LE, Marlin DJ, et al. Cardiac output measured by lithium dilution, thermodilution and transoesophageal Doppler echocardiography in anaesthetized horses. Am J Vet Res. 2001;61(7):731-737.
36.
Garcia-Rodriguez C., Pittman J., Cassell CH, et al. Cardiac output measurement without pulmonary artery or central venous catheterization: a clinical assessment of the lithium indicator dilution method. Crit Care Med. 2002;30(10):2199-2204.
37.
McGee WT , Horswell JL, Calderon J., et al. Validation of a continuous, arterial pressure-based cardiac output measurement: a multicenter, prospective clinical trial. Crit Care. 2007 ;11(5): R105.
38.
Manecke GR Jr , Auger WRCardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. J Cardiothorac Vasc Anesth. 2007 ;21(1):3-7.
39.
Gan TJ, Soppitt A., Maroof M., et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology. 2002;97(4):820-826.
40.
Wheeler AP, Bernard GR, Thompson BT, et al., and the The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network.Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213-2224.
41.
Wiedemann HP , Wheeler AP, Bernard GR, and the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS).Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564-2575.
42.
McGee W. , Burns M., Kozikowski K.Physiologic management of hemodynamics in the operating room using arterial pressure-based stroke volume and stroke volume variation. Poster presentation at CHEST Conference; October 2008; Philadelphia, PA.
43.
Pinsky MRProbing the limits of arterial pulse contour analysis to predict preload responsiveness . Anesth Analg. 2003;96(5): 1245-1247.
44.
Roeck M., Jakob SM, Boehlen T., Brander L., Knuesel R., Takala J.Change in stroke volume in response to fluid challenge: assessment using esophageal Doppler. Intensive Care Med. 2003; 29(10):1729-1735.
45.
Vallee F., Fourcade O., De Soyres O., et al. Stroke output variations calculated by esophageal Doppler is a reliable predictor of fluid response. Intensive Care Med . 2005;31(10):1388-1393.
46.
Kern JW, Shoemaker WCMeta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med. 2002;30(8): 1686-1692.
47.
Pinsky MR, Vincent JLLet us use the pulmonary artery catheter correctly and only when we need it . Crit Care Med. 2005;33(5): 1119-1122.
48.
Sandham JD, Hull RD, Brant RF, and the Canadian Critical Care Clinical Trials Group.A randomized, controlled trial of the use of pulmonary-artery catheters in high risk surgical patients. N Engl J Med. 2003;348(1):5-14.
49.
Harvey S., Harrison DA, Singer M., et al. Assessment of the clinical effectiveness of pulmonary catheters in management of patients in intensive care (PAC-Man): a randomized controlled trial. Lancet. 2005;366(9484):472-477.
50.
Binanay C., Califf RM, Hasselblad V., et al., for the ESCAPE Investigators and ESCAPE Study Coordinators.Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294(13):1625-1633.
51.
Richard C., Warszawski J., Anguel N., et al., for the French Pulmonary Artery Catheter Study Group.Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2003;290(20):2713-2720.
52.
Otero RM, Nguyen B., Huang D., et al. Early goal-directed therapy in severe sepsis and sepsis shock revisited: concepts, controversies, and contemporary findings. Chest. 2006;130(5):1579-1595.
53.
Rivers E., Nguyen B., Havstad S., et al., and the 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(19):1368-1377.
54.
Kandel G., Aberman A.Mixed venous oxygen saturation: its role in the assessment of the critically ill patient. Arch Intern Med. 1983 ;143(7):1400-1402.
55.
Kasnitz P., Druger GL, Torra F., Simmons DHMixed venous oxygen tension and hyperlactatemia. Survival in severe cardiopulmonary disease. JAMA. 1976;236(6):570-574.
56.
Reinhart K.Monitoring O2 transport and tissue oxygenation in critically ill patients . In: Reinhart K, Eyrich K, eds. Clinical Aspects of O2 Transport and Tissue Oxygenation. Berlin, Germany: Springer ; 1989 :195-211.
57.
Reinhart K. , Kuhn HU, Hartog C., Bredle DLContinuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med. 2004;30(8):1572-1578.
58.
Lee J., Wright F., Barber R., Stanley L.Central venous oxygen saturation in shock: a study in man. Anesthesiology. 1972; 36(5):472.
59.
Michard F., Teboul JL, Richard C.Influence of tidal volume on stroke volume variation. Does it really matter?Intensive Care Med. 2003;29(9):1613.
60.
Pinsky MRFunctional hemodynamic monitoring. Intensive Care Med. 2002;28(4):386-388.
61.
Perel A.The value of functional hemodynamic parameters in hemodynamic monitoring of ventilated patients. Anaesthetist. 2003 ;52(11):1003-1004.
62.
Magder S.Clinical usefulness of respiratory variations in arterial pressure . Am J Respir Crit Care Med. 2004;169(2):151-155.
63.
Reuter DA, Bayerlein J., Goepfert MS, et al. Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients . Intensive Care Med. 2003;29(3):476-480.
64.
Teboul JL, Monnet X., Richard C.Arterial pulse pressure variation during positive pressure ventilation and passive leg raising. In: Pinsky MR , Payen D, eds. Update in Intensive Care and Emergency Medicine: Functional Hemodynamic Monitoring . Germany: Springer-Verlag Berlin Heidelberg; 2005:331-343.
65.
Monnet X., Rienzo M., Osman D., et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34(5):1559-1560.
66.
Boulain T., Achard JM, Teboul JL, Richard C., Perrotin D., Ginies G.Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest. 2002;121(4):1245-1252.
67.
Teboul JL, Monnet X.Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity. Curr Opin Crit Care. 2008 ;14(3):334-339.
