• Benjamin de Witt, Raj Joshi, Harvey Meislin, and Jarrod M Mosier.
• Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
• J Emerg Med. 2014 Nov 1;47(5):608-15.

BackgroundAssessing volume responsiveness, defined as an increase in cardiac index after infusion of fluids, is important when caring for critically ill patients in septic shock, as both under- and over-resuscitation can worsen outcomes. This review article describes the currently available methods of assessing volume responsiveness for critically ill patients in the emergency department, with a focus on patients in septic shock.ObjectiveThe single-pump model of the circulation utilizing cardiac-filling pressures is reviewed in detail. Additionally, the dual-pump model evaluating cardiopulmonary interactions both invasively and noninvasively will be described.DiscussionCardiac filling pressures (central venous pressure and pulmonary artery occlusion pressure) have poor performance characteristics when used to predict volume responsiveness. Cardiopulmonary interaction assessments (inferior vena cava distensibility/collapsibility, systolic pressure variation, pulse pressure variation, stroke volume variation, and aortic flow velocities) have superior test characteristics when measured either invasively or noninvasively.ConclusionCardiac filling pressures may be misleading if used to determine volume responsiveness. Assessment of cardiopulmonary interactions has superior performance characteristics, and should be preferentially used for septic shock patients in the emergency department.Copyright © 2014 Elsevier Inc. All rights reserved.

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