Fluid Responsiveness is Not the Same as Fluid Benefit
Fluid responsiveness has been a hot topic for some time. Although with an easy conceptual definition (responding to volume expansion by increasing cardiac output), its practical assessment has been the subject of research, debate and some controversy, for the past 15 to 20 years. The problem is that fluid responsiveness is not the same as fluid benefit. And we have been wasting time researching in ways to predict fluid responsiveness. I really do not want to know if the patient is fluid responsive or not (are not we all?), but rather if fluid expansion is beneficial or detrimental to that specific patient, on that specific moment. We test patients in shock for fluid responsiveness. If, whatever the method we use, we find them to be responsive, we do intravenous fluids. We only stop fluid loading/fluid expansion if one of two things happen: if the patient is no longer in shock, or if the patient is no longer fluid responsive. We would never use a drug with proven harm, especially if its benefit was insufficiently proven. Nevertheless we continue to use fluids in scenarios in which their harm is proven, but their benefit is not. We need a paradigm shift. We need to stop looking for ways to predict fluid responsiveness. We must search for ways to identify which patients benefit from fluid expansion, fluid depletion or a neutral fluid strategy. New trials should prospectively compare well defined fluid strategies (expansion, depletion or neutral) to be applied depending on a set of predetermined tests. Until then, we will end up with the same question: will this specific patient, at this specific moment, benefit from fluid expansion, fluid depletion or a neutral fluid strategy?
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| Format: | Digital revista |
| Language: | English |
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Sociedade Portuguesa de Medicina Interna
2019
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| Online Access: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-671X2019000100014 |
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