Critical Care Lecture Series


Summary Slide for Fluid Management in Septic Shock


guyton bench to bedside






Guyton Physiology

Magder S. More respect for the CVP. Intensive Care Med. 1998 Jul;24(7):651-3. doi: 10.1007/s001340050640. PMID: 9722033.

Magder S. Bench-to-bedside review: An approach to hemodynamic monitoring–Guyton at the bedside. Crit Care. 2012 Oct 29;16(5):236. doi: 10.1186/cc11395. PMID: 23106914

Magder S. Volume and its relationship to cardiac output and venous return. Crit Care. 2016 Sep 10;20(1):271. doi: 10.1186/s13054-016-1438-7. Erratum in: Crit Care. 2017 Jan 26;21(1):16. PMID: 27613307

Fluid responsiveness and outcomes

Bednarczyk JM, Fridfinnson JA, Kumar A, Blanchard L, Rabbani R, Bell D, Funk D, Turgeon AF, Abou-Setta AM, Zarychanski R. Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis. Crit Care Med. 2017 Sep;45(9):1538-1545. doi: 10.1097/CCM.0000000000002554. PMID: 28817481

Ehrman RR, Gallien JZ, Smith RK, Akers KG, Malik AN, Harrison NE, Welch RD, Levy PD, Sherwin RL. Resuscitation Guided by Volume Responsiveness Does Not Reduce Mortality in Sepsis: A Meta-Analysis. Crit Care Explor. 2019 May 23;1(5):e0015. doi: 10.1097/CCE.0000000000000015. PMID: 32166259

Azadian M, Win S, Abdipour A, Kim CK, Nguyen HB. Mortality Benefit From the Passive Leg Raise Maneuver in Guiding Resuscitation of Septic Shock Patients: A Systematic Review and Meta-Analysis of Randomized Trials. J Intensive Care Med. 2022 May;37(5):611-617. doi: 10.1177/08850666211019713. Epub 2021 Jun 2. PMID: 34075833.

Richard JC, Bayle F, Bourdin G, Leray V, Debord S, Delannoy B, Stoian AC, Wallet F, Yonis H, Guerin C. Preload dependence indices to titrate volume expansion during septic shock: a randomized controlled trial. Crit Care. 2015 Jan 8;19(1):5. doi: 10.1186/s13054-014-0734-3. PMID: 25572383

Intravascular Crystalloid in Healthy and Septic Patients

Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section. Anesthesiology. 1999 Dec;91(6):1571-6. doi: 10.1097/00000542-199912000-00006. PMID: 10598596.

Sánchez M, Jiménez-Lendínez M, Cidoncha M, Asensio MJ, Herrerot E, Collado A, Santacruz M. Comparison of fluid compartments and fluid responsiveness in septic and non-septic patients. Anaesth Intensive Care. 2011 Nov;39(6):1022-9. doi: 10.1177/0310057X1103900607. PMID: 22165353.

Nunes TS, Ladeira RT, Bafi AT, de Azevedo LC, Machado FR, Freitas FG. Duration of hemodynamic effects of crystalloids in patients with circulatory shock after initial resuscitation. Ann Intensive Care. 2014 Aug 1;4:25. doi: 10.1186/s13613-014-0025-9. PMID: 25593742

Elevated CVP associated with Mortality and AKI

Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011 Feb;39(2):259-65. doi: 10.1097/CCM.0b013e3181feeb15. PMID: 20975548.

Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, Payen D. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013 Nov 29;17(6):R278. doi: 10.1186/cc13133. PMID: 24289206

Li DK, Wang XT, Liu DW. Association between elevated central venous pressure and outcomes in critically ill patients. Ann Intensive Care. 2017 Aug 9;7(1):83. doi: 10.1186/s13613-017-0306-1. PMID: 28795349

Chen CY, Zhou Y, Wang P, Qi EY, Gu WJ. Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis. Crit Care. 2020 Mar 5;24(1):80. doi: 10.1186/s13054-020-2770-5. PMID: 32138764

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. doi: 10.1056/NEJMoa010307. PMID: 11794169.

IVC and the Right Heart

Ruge M, Marhefka GD. IVC measurement for the noninvasive evaluation of central venous pressure. J Echocardiogr. 2022 Sep;20(3):133-143. doi: 10.1007/s12574-022-00569-6. Epub 2022 Apr 1. PMID: 35362870.

Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010 Mar;55(3):290-5. doi: 10.1016/j.annemergmed.2009.04.021. Epub 2009 Jun 25. PMID: 19556029.

Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8. doi: 10.1016/j.echo.2010.05.010. PMID: 20620859.

Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound. 2016 Aug 20;14(1):33. doi: 10.1186/s12947-016-0076-1. PMID: 27542597; PMCID: PMC4992235.

Jue J, Chung W, Schiller NB. Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? J Am Soc Echocardiogr. 1992 Nov-Dec;5(6):613-9. doi: 10.1016/s0894-7317(14)80327-1. PMID: 1466886.

Venous Congestion and Solid Organ Doppler

Kitai T, Tang WHW. Intrarenal Venous Flow: A Distinct Cardiorenal Phenotype or Simply a Marker of Venous Congestion? J Card Fail. 2021 Jan;27(1):35-39. doi: 10.1016/j.cardfail.2020.12.001. Epub 2020 Dec 8. PMID: 33301897.

Beaubien-Souligny W, Eljaiek R, Fortier A, Lamarche Y, Liszkowski M, Bouchard J, Denault AY. The Association Between Pulsatile Portal Flow and Acute Kidney Injury after Cardiac Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth. 2018 Aug;32(4):1780-1787. doi: 10.1053/j.jvca.2017.11.030. Epub 2017 Nov 22. PMID: 29277304.

Beaubien-Souligny W, Benkreira A, Robillard P, Bouabdallaoui N, Chassé M, Desjardins G, Lamarche Y, White M, Bouchard J, Denault A. Alterations in Portal Vein Flow and Intrarenal Venous Flow Are Associated With Acute Kidney Injury After Cardiac Surgery: A Prospective Observational Cohort Study. J Am Heart Assoc. 2018 Oct 2;7(19):e009961. doi: 10.1161/JAHA.118.009961. PMID: 30371304

Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, Denault AY. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020 Apr 9;12(1):16. doi: 10.1186/s13089-020-00163-w. PMID: 32270297


Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res. 2017 Oct 1;113(12):1474-1485. doi: 10.1093/cvr/cvx160. PMID: 28957537.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8. doi: 10.1016/j.echo.2010.05.010. PMID: 20620859.

Vieillard-Baron A, Prigent A, Repessé X, Goudelin M, Prat G, Evrard B, Charron C, Vignon P, Geri G. Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness. Crit Care. 2020 Nov 1;24(1):630. doi: 10.1186/s13054-020-03345-z. PMID: 33131508;

Lanspa MJ, Cirulis MM, Wiley BM, Olsen TD, Wilson EL, Beesley SJ, Brown SM, Hirshberg EL, Grissom CK. Right Ventricular Dysfunction in Early Sepsis and Septic Shock. Chest. 2021 Mar;159(3):1055-1063. doi: 10.1016/j.chest.2020.09.274. Epub 2020 Oct 14. PMID: 33068615;

Vallabhajosyula S, Shankar A, Vojjini R, Cheungpasitporn W, Sundaragiri PR, DuBrock HM, Sekiguchi H, Frantz RP, Cajigas HR, Kane GC, Oh JK. Impact of Right Ventricular Dysfunction on Short-term and Long-term Mortality in Sepsis: A Meta-analysis of 1,373 Patients. Chest. 2021 Jun;159(6):2254-2263. doi: 10.1016/j.chest.2020.12.016. Epub 2021 Feb 27. PMID: 33359215; PMCID: PMC8579312.

Blanco P. Rationale for using the velocity-time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings. Ultrasound J. 2020 Apr 21;12(1):21. doi: 10.1186/s13089-020-00170-x. PMID: 32318842

Shaikh F, Kenny JE, Awan O, Markovic D, Friedman O, He T, Singh S, Yan P, Qadir N, Barjaktarevic I. Measuring the accuracy of cardiac output using POCUS: the introduction of artificial intelligence into routine care. Ultrasound J. 2022 Dec 14;14(1):47. doi: 10.1186/s13089-022-00301-6. PMID: 36517635

Zhai S, Wang H, Sun L, Zhang B, Huo F, Qiu S, Wu X, Ma J, Wu Y, Duan J. Artificial intelligence (AI) versus expert: A comparison of left ventricular outflow tract velocity time integral (LVOT-VTI) assessment between ICU doctors and an AI tool. J Appl Clin Med Phys. 2022 Aug;23(8):e13724. doi: 10.1002/acm2.13724. Epub 2022 Jul 11. PMID: 35816461

Lung Ultrasound

Lichtenstein DA, Mezière GA, Lagoueyte JF, Biderman P, Goldstein I, Gepner A. A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest. 2009 Oct;136(4):1014-1020. doi: 10.1378/chest.09-0001. PMID: 19809049.

Volpicelli G, Skurzak S, Boero E, Carpinteri G, Tengattini M, Stefanone V, Luberto L, Anile A, Cerutti E, Radeschi G, Frascisco MF. Lung ultrasound predicts well extravascular lung water but is of limited usefulness in the prediction of wedge pressure. Anesthesiology. 2014 Aug;121(2):320-7. doi: 10.1097/ALN.0000000000000300. PMID: 24821071.