Cardiopulmonary interactions and volume status assessment

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Assessment of the hemodynamics and volume status is an important daily task for physicians caring for critically ill patients. There is growing consensus in the critical care community that the traditional methods-e.g. central venous pressure or pulmonary artery occlusion pressure-used to assess volume status and fluid responsiveness are not well supported by evidence and can be misleading. Our purpose is to provide here an overview of the knowledge needed by ICU physicians to take advantage of mechanical cardiopulmonary interactions to assess volume responsiveness. Although not perfect such dynamic assessment of fluid responsiveness can be helpful particularly in the passively ventilated patients. We discuss the impact of phasic changes in lung volume and intrathoracic pressure on the pulmonary and systemic circulation and on the heart function. We review how respirophasic changes on the venous side (great veins geometry) and arterial side (e.g. stroke volume/systolic blood pressure and surrogate signals) can be used to detect fluid responsiveness or hemodynamic alterations commonly encountered in the ICU. We review the physiological limitations of this approach.

Original languageEnglish (US)
Pages (from-to)383-391
Number of pages9
JournalJournal of Clinical Monitoring and Computing
Volume26
Issue number5
DOIs
StatePublished - Oct 1 2012

Keywords

  • Cardiopulmonary interactions
  • Fluid responsiveness
  • Physiology
  • Pulse pressure variation
  • Stroke volume variation
  • Vena cava ultrasound
  • Volume status

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