Fluid challenge

Hypovolaemia must be treated urgently to avoid the serious complication of organ failure. An adequate circulating volume must be provided before considering other methods of circulatory support. Clinical signs of hypovolaemia (reduced skin turgor, low CVP, oliguria, tachycardia and hypotension) are late indicators. Lifting the legs of a supine patient and watching for an improvement in the circulation is a useful indicator of hypovolaemia. A high index of suspicion must be maintained; a normal heart rate, blood pressure and CVP do not exclude hypovolaemia and the CVP is particularly unreliable in pulmonary vascular disease, right ventricular disease, isolated left ventricular failure and valvular heart disease. The absolute CVP or PAWP are also difficult to interpret since peripheral venoconstriction may maintain these filling pressures despite hypovolaemia; indeed, they may fall in response to fluid. The response to a fluid challenge is the safest method of assessment.

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