The Physiology of Volume Resuscitation

Abstract

Currently static and dynamic indices of fluid responsiveness are used to guide fluid resuscitation. The physiological effect of a fluid bolus is considered in terms of the Frank–Starling mechanism. This is, however, an incomplete concept and ignores the effect of the venous system. This paper reviews the interplay between the stressed and unstressed volume, the mean circulatory filling pressure and the central venous pressure in determining organ and microcirculatory flow. We also review method for determining fluid responsiveness.