• Optimal volaemic status
    • Favourable outcomes are achieved by goal-directed fluid therapy
    • Excess fluid
      • Predisposes to pneumonia
      • Respiratory failure
      • Poor wound healing
      • Inhibition of gastric motility
    • The expected response to fluid is an increase in SV and therefore co. This depends on ventricular function so only some critically ill patients will respond
    • Assessing volume status in mechanically ventilated patients
      • Static parameters
        • Less valuable than dynamic parameters
        • CVP & PAOP
          • Likely only to be useful at extremes of filling
        • RVEDV & LVEDA
          • RVEDV measured by PAC or scintigraphy
          • LVEDA measured by TOE
        • Global EDV & IT blood volume
          • Avoidable using PiCCO. GEDV has been validated as an indicator of preload
      • Dynamic parameters
        • SVV
          • SVV of 9.5% predicts SV increase of 5% in response to 100ml bolus
        • Pulse pressure variation
          • Non-responders if <13%
        • Systolic pressure variation
        • Aortic blood velocity
          • A change in peak velocity between high/low values throughout the respiratory cycle of 12% discriminates between responders and non-responders
        • Superior vena cava collapsibility index and IVC distensibility index
          • Assessed by Echo
            Link:echo on itu
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/early/2010/02/25/bjaceaccp.mkq002.full.pdf?frame=sidebar