How a dynamic measurement can inform clinical decisions and personalize care
Baxter's Jennifer Sahatjian, associate director of clinical affairs, explains how monitoring a patient's fluid responsiveness can impact individual treatment.
Q: Why is measuring fluid responsiveness important?
Jennifer: More than 80 percent of hospitalized patients receive IV fluids.1 For example, fluid can be used to aid resuscitation in critically ill patients, treat dehydration, or increase tissue perfusion in shock. The types of fluids and their clinical use cases are vast. However, fluid administration is not a one-size-fits-all approach. In fact, giving a patient too little or too much fluid can lead to serious complications2 and we recommend a personalized approach to fluid treatment, including first assessing whether a patient is fluid responsive.
Q: When would a clinician measure a patient’s fluid responsiveness?
Jennifer: While fluid therapy is used broadly throughout hospital and clinical settings, it’s most critical to evaluate fluid responsiveness prior to fluid administration when a patient is respiratory compromised, hypotensive, bleeding or in need of a fluid bolus. For example, I recently participated in a clinical trial, the FRESH study, that analyzed fluid management in patients with septic shock and demonstrated the benefits of using dynamic measurements to guide fluid therapy decisions for these patients.
Q: What does an assessment of fluid responsiveness tell a clinician about a patient?
Jennifer: An assessment can help determine how a patient will respond to fluids, and whether administering IV fluids might benefit or harm that individual. We particularly look at stroke volume, the amount of blood the heart pumps with each beat, and monitor how much it changes during a short fluid responsiveness evaluation. If there is no change in stroke volume, that means the patient’s system may not be able to handle additional fluid at that time, and alternative treatment should be considered.
Q: How is fluid responsiveness evaluated?
Jennifer: A clinician can either administer a patient a fluid bolus – a small amount of fluid administered through their IV – or perform a noninvasive passive leg raise (PLR). During a PLR, a patient’s legs are raised to a 45-degree angle, causing additional blood to flow from the lower body into the heart. In both cases, a clinician will monitor if and how stroke volume changes to determine whether fluid therapy is right for that patient at that time.
Want more details about fluid management? Review the FRESH study referenced above.