Critical Matters Fluid Responsiveness
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Jan 27, 2022 
Haney Mallemat, a critical care intensivist and ultrasound expert at Cooper University Health, dives deep into the nuances of fluid resuscitation. He discusses the balance between the benefits and potential harms of fluid therapy, emphasizing the importance of predicting fluid responsiveness. Haney highlights dynamic versus static assessment techniques, including the use of ultrasound to assess the IVC and the effectiveness of tests like passive leg raises. He also pushes for a thoughtful approach to fluid administration, treating it like a medication rather than a blanket solution.
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Fluids Have One Purpose
- Fluids are given only to increase stroke volume as the single therapeutic aim.
- Being fluid responsive does not always mean the patient needs fluids now.
Fluid Overload Harms Organs
- Excessive fluid causes organ interstitial edema and cellular swelling that impairs organ function.
- Volume overload links to acute kidney injury and prolonged ICU delirium through cellular ischemia.
Use 10–15% Stroke Volume Threshold
- Define fluid responsiveness as a 10–15% increase in stroke volume after increasing preload.
- Use that threshold to judge whether giving fluids will likely raise cardiac output.