M Velia Antonini

M Velia Antonini

19-05-2022

14:34

Why to assess preload responsiveness? 💧NOT all pts even in shock are fluid responsive 💧assess frequently: dynamic phenomenon 💧fluids in non-responders? risky 💧overload harmful: +ve balance ⬆️ mortality 💧use of fluid responsiveness tests ⬆️ outcome Teboul JL @ESICM webinar 🧵

Fluids (preload) responsiveness equivalent to biventricular responsiveness 🫀 Frank-Starling curve family of curves, from normal to failing heart 🫀 steep portion of curve? preload responsiveness 🫀 flat portion? no ⬆️ in SV = preload unresponsiveness Teboul JL @ESICM webinar 🧵

💧PLR/EEO mimic fluid challenge w/o need for any fluid 🫀 changes in CO post PLR/EEO reliably predict responsiveness 🫀 PPV does not require CO but sometimes not reliable 🫀 ⬆️ PPV during Vt challenge or ⬇️ PPV during PLR predict responsiveness if low Vt MV Teboul JL @ESICM 🧵

Even in case of fluid responsiveness mandatory to assess benefit/risk ratio before giving fluids particularly if #ARDS 💧benefit = degree of responsiveness 💧 isk = indices of lung tolerance: P/F ratio, EVLW, PAWP, B lines... Do pt really needs fluids? Teboul JL @ESICM webinar 🧵



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