Assessment of fluid responsiveness during increased intra-abdominal pressure: keep the indices, but change the thresholds

Crit Care. 2011;15(2):134. doi: 10.1186/cc10074. Epub 2011 Mar 18.

Abstract

Dynamic variables of fluid responsiveness are useful guides for fluid management in patients under controlled positive pressure ventilation. In the previous issue of Critical Care, Jacques and colleagues show that these variables remain reliable predictors of fluid responsiveness in a porcine model of intra-abdominal hypertension, but threshold values are higher than during normal intra-abdominal pressure. Their threshold values, however, cannot be applied to clinical practice. This study suggests that intra-abdominal pressure must be measured in critically ill patients, and 'supranormal' values of dynamic variables should be analyzed with caution. The 'fluid responsive part' of an increased dynamic variable in such patients may be estimated by measuring its change during a fluid challenge.

Publication types

  • Comment

MeSH terms

  • Animals
  • Blood Pressure / physiology*
  • Fluid Therapy*
  • Intra-Abdominal Hypertension / physiopathology*
  • Stroke Volume / physiology*