Anesth Analg 2006;102:651-652
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000190765.48530.5C
LETTER TO THE EDITOR
Differentiating "Volumetric Preload Monitoring" and Assessing "Fluid Responsiveness"
Daniel A. Reuter, MD, and
Alwin E. Goetz, MD, PhD
Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, dreuter{at}uke.uni-hamburg.de
To the Editor:
With great interest we read the concise review article by Grocott et al. (1). However, the authors did not differentiate between assessing "static" preload parameters considered to be indicative for cardiac filling volumes and assessing "fluid responsiveness," the latter predicting the hemodynamic response to fluid loading (2). Measuring "static preload" allows quantifying a patient’s intravascular volume status and its changes over time. Numerous studies in different groups of patients demonstrated that volumetric parameters, such as the left ventricular end-diastolic area by transesophageal echocardiography (3) or the global end-diastolic volume by transcardiopulmonary thermodilution (4), are much more useful to answer that clinical question than measuring cardiac filling pressures. The more important question to answer in a hemodynamically instable patient is: will this patient benefit from fluid loading by an increase in cardiac output? Specifically, in patients with compromised cardiac function, this question has to be answered before fluid loading to prevent potentially deleterious fluid overload. This "prediction of fluid responsiveness" is the ratio behind the so-called "functional preload parameters," such as the systolic pressure variation and stroke volume variation. First systolic pressure variation, and later stroke volume variation, as continuous "on-line parameters" have been shown to predict fluid responsiveness in a wide range of surgical and septic patients (5-10). Thus, those parameters seem to represent useful clinical tools for more rational perioperative fluid management in mechanically ventilated patients.
References
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- Reuter DA, Felbinger TW, Kilger E, et al. Optimising fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations - a comparison to aortic systolic pressure variations. Br J Anaesth 2002;88:124-6.[Abstract/Free Full Text]
- Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variations to assess fluid responsiveness in patients with reduced left ventricular function. Crit Care Med 2003;31:1399-404.[ISI][Medline]
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