You are evaluating a 65yo male with PMH CHF presents with severe sepsis. You’d like to administer IV crystalloids but you’re not sure how much should be given. What are some tools to assess for fluid responsiveness?
Assess for fluid responsiveness:
– Passive Leg Raise [1]
[2]
- Technique: From a semi-recumbent position with head at 45-degs, lower upper portion of stretcher and raise legs to 45 degs.
- Give more fluids if 10% inc in stroke volume or pulse pressure
– IVC Ultrasound [3]
- Technique: assess IVC diameter just caudal to hepatic veins
- Give more fluids if ≥30% collapse with inspiration -> fluid bolus
– CVP (If central line in place) [3]
- Give fluids until CVP > 10 if non-intubated or CVP > 14 if intubated
- Give fluids if CVP decrease by 2 mmHg with deep inspiration
– Assess for fluid overload:
SOB, hypoxemia, tachypnea, CXR, Lung U/S (≥3 B-lines in one intercostal space)
Sources:
- http://lifeinthefastlane.com/ccc/passive-leg-raise/
- http://crashingpatient.com/resuscitation/predicting-fluid-responsiveness.htm/
- http://emcrit.org/severe-sepsis-resources/evidence/
- MSSM Division of Emergency Critical Care: Severe Sepsis Protocol and Assessing Fluid Responsiveness
