Hypovolaemia

DETRIMENTAL EFFECTS

Detrimental effects are due to impaired cardiac output and organ perfusion and oxygen delivery

  • oliguria -> ATN -> cortical necrosis -> ARF
  • cerebral ischaemia -> confusion -> decreased LOC -> infarction
  • myocardial ischaemia -> cardiogenic shock -> heart failure
  • gastrointestinal ischaemia and hepatic failure
  • limb ischaemia
  • lactic acidosis

-> single most important cause of hypotension and ICU morbidity

PREVENTION

  • early detection (education of the clinical features: tachycardia, hypotension, oliguria and confusion)
  • looking for features that may mask hypovolaemia: drugs (beta-blockers), pre-existing conditions (autonomic dysfunction), ‘normal’ physiology (elite athlete, pregnancy, young)
  • use dynamic measures not just isolated numbers (CVP, PAOP)
  • fluid responsiveness: 10mL/kg bolus, raise legs -> response to haemodynamic variables
  • don’t use diuretics as response to oliguria
  • basal crepitation don’t preclude a fluid challenge
  • use invasive monitoring in complex cases (PAC, Echo, Lines, PiCCO, Oesophageal Doppler)
  • develop protocols to involve fluid challenges in resuscitation

CCC 700 6

Critical Care

Compendium

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