Diagnosing hypovolemia and hypervolemia: from clinical examination to modern methods

Czech version

Authors: MUDr. Jan Beneš ^1,2
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny LF UK a FN Plzeň ¹; Biomedicínské centrum LF UK Plzeň ²
Published in: Vnitř Lék 2019; 65(3): 170-176
Category:

Overview

In acutely ill patients, disturbances of circulating blood volume and water homeostasis are frequently encountered. In order to choose adequate treatment strategy a well based diagnostics of these disturbance sis necessary, because fluid therapy possess the potential not only to help but also to worsen patient’s state. Currently we have at hand several possibilities to diagnose hypovolemia or hypervolemia: besides standard clinical assessment novel approaches as dedicated laboratory markers or sonography. Tests of fluid responsiveness are other mean how to ensure that the acutely ill patient will receive just the right amount of fluids. In this review article we will present the current view of the circulating blood volume pathophysiology as well as contemporary diagnostic tools.

Keywords:

fluid challenge – fluid responsiveness – infusion therapy

Sources

Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res 2010; 87(2): 198–210. Dostupné z DOI: <http://dx.doi.org/10.1093/cvr/cvq062>.
Cerny V, Astapenko D, Brettner F et al. Targeting the endothelial glycocalyx in acute critical illness as a challenge for clinical and laboratory medicine. Crit Rev Clin Lab Sci 2017; 54(5): 343–357. Dostupné z DOI:<http://dx.doi.org/10.1080/10408363.2017.1379943>.
Bellamy M. Wet, dry or something else? Br J Anaesth 2006; 97(6): 755–757. Dostupné z DOI: <http://dx.doi.org/10.1093/bja/ael290>.
Mythen MG. Postoperative Gastrointestinal Tract Dysfunction. Anesth Analg 2005; 100(1): 196–204. Dostupné z DOI: <http://dx.doi.org/10.1213/01.ANE.0000139376.45591.17>.
Prowle JR, Echeverri JE, Ligabo EV et al. Fluid balance and acute kidney injury. Nat Rev Nephrol 2010; 6(2): 107–115. Dostupné z DOI: <http://dx.doi.org/10.1038/nrneph.2009.213>.
Malbrain MLNG, Roberts DJ, Sugrue M et al. The polycompartment syndrome: a concise state-of-the-art review. Anaesthesiol Intensive Ther 2014; 46(5): 433–450. Dostupné z DOI: <http://dx.doi.org/10.5603/AIT.2014.0064>.
Acheampong A, Vincent J. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 2015; 19: 251. Dostupné z DOI: <http://dx.doi.org/10.1186/s13054–015–0970–1>.
Benes J. Cumulative Fluid Balance. Crit Care Med 2016; 44(10): 1945–1946. Dostupné z DOI: <http://dx.doi.org/10.1097/CCM.0000000000001919>.
Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016; 17(1): 109. Dostupné z DOI: <http://dx.doi.org/10.1186/s12882–016–0323–6>.
Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care 2016; 6(1): 111. Dostupné z DOI: <http://dx.doi.org/10.1186/s13613–016–0216–7>.
Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med 2005; 31(10): 1316–1326. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–005–2790–2>.
Ait-Oufella H, Bourcier S, Alves M et al. Alteration of skin perfusion in mottling area during septic shock. Ann Intensive Care 2013; 3(1): 31. Dostupné z DOI: <http://dx.doi.org/10.1186/2110–5820–3-31>.
Di Nicolò P. The dark side of the kidney in cardio-renal syndrome: renal venous hypertension and congestive kidney failure. Heart Fail Rev 2018; 23(2): 291–302. Dostupné z DOI: <http://dx.doi.org/10.1007/s10741–018–9673–4>.
Marik P, Bellomo R. A rational approach to fluid therapy in sepsis. Br J Anaesth 2016; 116(3): 339–349. Dostupné z DOI: <http://dx.doi.org/10.1093/bja/aev349>.
Boyd JH, Forbes J, Nakada T et al. Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011; 39(2): 259–265. Dostupné z DOI: <http://dx.doi.org/10.1097/CCM.0b013e3181feeb15>.
Boyd JH, Sirounis D, Maizel J et al. Echocardiography as a guide for fluid management. Crit Care 2016; 20: 274. Dostupné z DOI: <http://dx.doi.org/10.1186/s13054–016–1407–1>.
J. Romero-Bermejo F, Ruiz-Bailen M, Guerrero-De-Mier M et al. Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient. Curr Cardiol Rev 2011; 7(3): 146–156.
Lichtenstein DA. BLUE-Protocol and FALLS-Protocol: Two applications of lung ultrasound in the critically ill. Chest 2015; 147(6): 1659–1670. Dostupné z DOI: <http://dx.doi.org/10.1378/chest.14–1313>.
Seif D, Perera P, Mailhot T et al. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol. Crit Care Res Pract 2012; 2012: 503254. Dostupné z DOI: <http://dx.doi.org/10.1155/2012/503254>.
Rhodes A, Evans LE, Alhazzani W et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43(3): 304–377. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–017–4683–6>.
Beneš J. Predikce odpovědi na podání tekutiny – tekutinová reaktivita. Prediction of fluid responsiveness. Anesteziol a Intenziv Med 2017; 28(1): 57–63.
Marik PE, Cavallazzi R, Vasu T et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature. Crit Care Med 2009; 37(9): 2642–2647. Dostupné z DOI: <http://dx.doi.org/10.1097/CCM.0b013e3181a590da>.
Bentzer P, Griesdale DE, Boyd J et al. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids? JAMA 2016; 316(12): 1298–1309. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2016.12310>.
Georges D, de Courson H, Lanchon R et al. End-expiratory occlusion maneuver to predict fluid responsiveness in the intensive care unit: an echocardiographic study. Crit Care 2018; 22(1): 32. Dostupné z DOI: <http://dx.doi.org/10.1186/s13054–017–1938–0>.
Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med 2016; 42(12): 1935–1947. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–015–4134–1>.
Monnet X, Teboul JL. Passive leg raising: five rules, not a drop of fluid! Crit Care 2015; 19: 18. Dostupné z DOI: <http://dx.doi.org/10.1186/s13054–014–0708–5>.
Jalil B, Thompson P, Cavallazzi R et al. Comparing Changes in Carotid Flow Time and Stroke Volume Induced by Passive Leg Raising. Am J Med Sci 2018; 355(2): 168–173. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjms.2017.09.006>.
Biais M, De Courson H, Lanchon R et al. Mini-fluid Challenge of 100 ml of Crystalloid Predicts Fluid Responsiveness in the Operating Room. Anesthesiology 2017; 127(3): 450–456. Dostupné z DOI: <http://dx.doi.org/10.1097/ALN.0000000000001753>.
Messina A, Longhini F, Coppo C et al. Use of the Fluid Challenge in Critically Ill Adult Patients. Anesth Analg 2017; 125(5): 1532–1543. Dostupné z DOI: <http://dx.doi.org/10.1213/ANE.0000000000002103>.
Cecconi M, Hofer C, Teboul JL et al. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Med 2015; 41(9): 1529–1537. Dostupné z DOI: <http://dx.doi.org/10.1007/s00134–015–3850-x>. Erratum in Erratum to: Fluid challenges in intensive care: the FENICE study: A global inception cohort study. [Intensive Care Med. 2015].

Labels

Diabetology Endocrinology Internal medicine

An unstable patient in first contact with a doctor in hospital: how to recognize the risk?

Importance of ultrasound examination in diagnosing acute conditions

Intravenous fluid therapy in acutely ill patients for non-intensivists

Acute respiratory distress syndrome

Initial antibiotic treatment of serious bacterial infections

Hemorrhagic shock and treatment of severe bleeding

Nutrition in the acute phase of illness

Article was published in

Internal Medicine

2019 Issue 3