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Monnet X, Teboul JL. Prediction of fluid responsiveness in spontaneously breathing patients. Ann Transl Med. 2020;8(12):790doi: 10.21037/atm-2020-hdm-18.
Monnet, X., & Teboul, J. L. (2020). Prediction of fluid responsiveness in spontaneously breathing patients. Annals of translational medicine, 8(12), 790. https://doi.org/10.21037/atm-2020-hdm-18
Monnet, Xavier, and Teboul, Jean-Louis. "Prediction of fluid responsiveness in spontaneously breathing patients." Annals of translational medicine vol. 8,12 (2020): 790. doi: https://doi.org/10.21037/atm-2020-hdm-18
Monnet X, Teboul JL. Prediction of fluid responsiveness in spontaneously breathing patients. Ann Transl Med. 2020 Jun;8(12):790. doi: 10.21037/atm-2020-hdm-18. PMID: 32647715; PMCID: PMC7333112.
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Ann Transl Med. 2020 Jun;8(12):790. doi: 10.21037/atm-2020-hdm-18.

Prediction of fluid responsiveness in spontaneously breathing patients.

Annals of translational medicine

Xavier Monnet, Jean-Louis Teboul

Affiliations

  1. Hôpitaux Universitaires Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Hôpital de Bicêtre, Service de Médecine Intensive-Réanimation, Le Kremlin-Bicêtre, France.
  2. Inserm UMR S_999, Univ Paris-Saclay, Le Kremlin-Bicêtre, France.

PMID: 32647715 PMCID: PMC7333112 DOI: 10.21037/atm-2020-hdm-18

Abstract

In patients with acute circulatory failure, the primary goal of volume expansion is to increase cardiac output. However, this expected effect is inconstant, so that in many instances, fluid administration does not result in any haemodynamic benefit. In such cases, fluid could only exert some deleterious effects. It is now well demonstrated that excessive fluid administration is harmful, especially during acute respiratory distress syndrome and in sepsis or septic shock. This is the reason why some tests and indices have been developed in order to assess "fluid responsiveness" before deciding to perform volume expansion. While preload markers have been used for many years for this purpose, they have been repeatedly shown to be unreliable, which is mainly related to physiological issues. As alternatives, "dynamic" indices have been introduced. These indices are based upon the changes in cardiac output or stroke volume resulting from various changes in preload conditions, induced by heart-lung interactions, postural manoeuvres or by the infusion of small amounts of fluids. The haemodynamic effects and the reliability of these "dynamic" indices of fluid responsiveness are now well described. From their respective advantages and limitations, it is also possible to describe their clinical interest and the clinical setting in which they are applicable.

2020 Annals of Translational Medicine. All rights reserved.

Keywords: Volume expansion; heart-lung interactions; passive leg raising (PLR)

Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-2020-hdm-18). The series “Hemodynamic monitoring in critically ill pat

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