NJCC_01 v7 bwerk.indd

Fluid administration in critically ill patients is an important everyday therapeutic measure to improve organ perfusion. However, during the past decade, excessive fluid administration has been related to increased morbidity and mortality. This has led to the hypotheses that fluid administration without increasing cardiac output is inappropriate and is of no benefit to the patient. Over the past 10 years, many parameters for the prediction of fluid responsiveness have been suggested and validated. Implementation of these parameters in clinical practice may reduce the amount of inappropriate fluid. In this paper we discuss these methods for predicting fluid responsiveness and present a clinical strategy for fluid resuscitation. We make separate recommendations for patients on controlled mechanical ventilation, on mechanical ventilation with spontaneous activity and those breathing spontaneously.