ICU Vivas · Resuscitation
Equipment viva — the arterial line and the echo for fluid responsiveness
An equipment viva on the two bedside tools that underpin the fluid-responsiveness assessment — the arterial line (the pulse-pressure variation) and the focused echocardiogram (the stroke volume and the passive-leg-raise response) — their principles, their use, and their pitfalls.
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Prompt
An equipment viva on the two bedside tools that underpin the fluid-responsiveness assessment — the arterial line (the pulse-pressure variation) and the focused echocardiogram (the stroke volume and the passive-leg-raise response) — their principles, their use, and their pitfalls.
Overview
The fluid-responsiveness assessment rests on two bedside tools. The arterial line measures the beat-to-beat arterial pressure, from which the pulse-pressure variation is derived; and the focused echocardiogram measures the stroke volume and the cardiac output, the response to a passive leg raise, and the ventricular function that frames the whole. Together they convert the fluid decision from a guess into a measured test.[3]
References3ShowHide
- [1]Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. American Journal of Respiratory and Critical Care Medicine, 2000.PMID 10903232
- [2]Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Critical Care Medicine, 2006.PMID 16540963
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.