Assessing volume status and fluid responsiveness in the emergency department

Abstract

Resuscitation with intravenous fluid can restore intravascular volume and improve stroke vol - ume. However, in unstable patients, approximately 50% of fluid boluses fail to improve cardiac output as intended. Increasing evidence suggests that excess fluid may worsen patient outcomes. Clinical examination and vital signs are unreliable predictors of the response to a fluid challenge. We review the importance of fluid management in the critically ill, methods of evaluating vol - ume status, and tools to predict fluid responsiveness.