12 RC 3 Assessment of volume responsiveness

Assessing hypovolaemia and predicting volume responsiveness is a difficult challenge in most critically ill patients and surgical patients. Clinicians have to deal with three different scenarios: • Patients who present in the Emergency Department with evident acute body fluid losses. The diagnosis of hypovolaemia is almost certain and a positive haemodynamic response to volume resuscitation will occur. Patients admitted to the Emergency Department likely to be in septic shock. There is no need for sophisticated parameters to predict volume responsiveness since a positive haemodynamic response is always expected. • Patients who have been in the ICU for several hours or patients in the operating room who experience haemodynamic instability. Fluid administration may represent a therapeutic dilemma. On one hand, one may expect a beneficial effect of fluid administration if the heart still has some preload reserve. On the other hand, because the patient has often been resuscitated already, the presence of preload reserve is not guaranteed and further fluid infusion has the potential to cause harm through development of pulmonary oedema.