Use of Ultrasound to Assess Fluid Responsiveness in the Intensive Care Unit~!2009-04-15~!2009-06-02~!2010-07-15~!

Determining the appropriate amount of fluid resuscitation to administer to a critically ill patient is a complex decision. Traditional tools for the assessment of preload sensitivity such as central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) are inaccurate in predicting whether a patient requires volume resuscitation (1). Diagnostic ultrasonography in the form of echocardiography offers an alternative means of determining whether a patient is preload sensitive. While the determination of the cause of hypotension in a trauma patient or one who is bleeding from a gastrointestinal source is straight forward, most patients in the medical ICU have multiple etiologies of shock. This requires careful assessment prior to institution of fluid therapy. Patients in the ICU who are hypotensive may be preload sensitive; however, in some circumstances, volume resuscitation may be detrimental (2, 3). For example, a patient in shock with acute cor-pulmonale and a dilated right ventricle should not receive volume resuscitation. Bedside echocardiography is a non-invasive tool that may be used to rapidly assess whether a patient with shock is fluid responsive.