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11 Fluid Therapy Should be Guided by Fluid Responsiveness
  1. J López-Herce,
  2. J Urbano
  1. Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Abstract

Background To predict fluid response is very Important because a little or excessive expansion may alter the prognosis of the child in shock.

Methods We review experimental and clinical articles in adult and children about parameters that could predict fluid responsiveness in shock. We also analyze our experimental data in pediatric experimental model of hemorrhagic shock.

Results The most used parameters to try to predict hemodynamic response to fluids are: static pressure parameters as central venous pressure (CVP); volume as global end diastolic ventricular index (GEDVI) or stroke volume index (SVI); dynamic parameters, as pulse pressure variation (PPV) and systolic volume variation (SVV), and the response to a maneuver that increases blood volume without expanding the patient (leg raises). Several studies in adults suggest that hemodynamic volume parameters (SVI or GEDVI) predict better the response to fluids than pressure parameters (PVC); that dynamic parameters (PPV and SVV) predict better the response to fluids that static parameters; and that maneuver leg raises maneuver is the best predictive parameter. However, the results of other studies are contradictory. In children there are few studies and there is no evidence that dynamic parameters are better predictors than static volume parameters. Our experimental studies confirm these findings. Preliminary data suggest that leg raise maneuver has not good predictive power in children.

Conclusion at this time fluid therapy in children with shock should be guided by fluid responsiveness. Macrohemodynamic, microhemodynamic and tissue parameters should be used to control the response to fluid therapy.

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