Fluid challenge

[prasanthms]

Sir in case of a septic shock patient with h/o ckd how to load crystalloids as initial fluid bolus also if patient has reduced ef how fast should the fluid be given.

 

[drankur]

its a clinical judgement :

both in low ef and ckd patient, you have take help of :
1. auscultation ,... signs of pulmonary odema
2. if central line in place... CVP
3. if usg there, IVC..
4. passive leg raise also helps .

also try giving small bolus of 100-200 ml, rather than 500 or 1000 ml bolus. this helps to access, re-access and act.

basically its all bedside clinical judgment...

 

[prasanthms]

its a clinical judgement :

both in low ef and ckd patient, you have take help of :
1. auscultation ,... signs of pulmonary odema
2. if central line in place... CVP
3. if use there, IVC..
4. passive leg raise also helps .

also try giving small bolus of 100-200 ml, rather than 500 or 1000 ml bolus. this helps to access, re-access and act.

basically its all bedside clinical judgment...

Thank you, sir.

 

[Glady]

Cvp has no role in fluid challenge these days na sir as per updates it has nothing to do with cardiac output and ideally veins have no pressure in them since they're capicatance vessels

 

[drankur]

ya this was the general updates,
but if you see the recent articles, CVP trend still have value.

 

[Aneeltdas]

In the UK now a days we use CVP lines mostly for infusions that have to be administered into a large vein like the SVC. Seldom do we use it to monitor central venous pressure. It is however, as mentioned by Dr Ankur, used for pressure trends. Most importantly the CVP value is used for Cardiac Output calculations.
Although veins are capacitance vessels they do have some pressure in them for forward blood flow.

 

[drankur]

In the UK now a days we use CVP lines mostly for infusions that have to be administered into a large vein like the SVC. Seldom do we use it to monitor central venous pressure. It is however, as mentioned by Dr Ankur, used for pressure trends. Most importantly the CVP value is used for Cardiac Output calculations.
Although veins are capacitance vessels they do have some pressure in them for forward blood flow.

thanks and welcome aneeltdas.

everyone please go through the following article of 2018 on this; see the authors!
this will give you more insights .

I am attaching the pdf also

Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions - Critical Care

The central venous pressure (CVP) is the most frequently used variable to guide fluid resuscitation in critically ill patients, although its use has been challenged. In this viewpoint, we use a question and answer format to highlight the potential advantages and limitations of using CVP...

ccforum.biomedcentral.com

 

[Aneeltdas]

Thanks