Volume 13
Number 3
Aug 2009
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BF Geerts, JJ Maas, RBP de Wilde, HIJ Harinck, JRC Jansen

Objective: Selection of patients who will benefit from fluid loading is critical since unnecessary fluid administration can lead to pulmonary oedema and cardiac failure. Filling pressures such as central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO) and clinical signs have traditionally been at the centre of haemodynamic monitoring. We performed a survey to evaluate the impact of recently introduced parameters and challenges in daily practice in Dutch intensive care units. Methods: 446 questionnaires were sent to ICU physicians in the Netherlands. Results: 39% of questionnaires were returned. In the initial assessment of volume status urine production and capillary refill were found most important. To estimate need for volume expansion; CVP was used by 70%, stroke volume variation (SVV) or pulse pressure variation (PPV) by 47%, and CO by 20%. Seventy-five percent used a fluid challenge to predict responsiveness. Changes in heart rate, MAP, CVP and CO were used most in characterizing responders and non-responders. The presence of guidelines to characterize hypo- or hypervolaemia was indicated by 25% and only half of these respondents indicated they used these guidelines. Conclusions: Many Dutch ICU physicians use the recently developed variables SVV and PPV as well as fluid challenges to predict the effects of fluid loading on CO, although, CVP is still used by the majority.

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