Volume expansion is a cornerstone of resuscitation for circulatory failure.
As discussed in previous pearls, only 50% of unstable critically ill patients respond to fluid therapy. For the 50% that don't respond, additional fluids may increase morbidity and mortality.
In recent years, there has been tremendous focus on dynamic markers of fluid responsiveness, including respirophasic changes in IVC diameter, passive leg raising, and pulse pressure variation (PPV).
An additional dynamic marker of fluid responsiveness is the end-expiratory occlusion test.
Unlike PPV, this test can be performed on patients with spontaneous breathing activity and those with cardiac arrhythmias.
Recent literature indicates that a 5% increase in cardiac output during a 15-second end-expiratory occlusion test predicts a positive response to a 500 ml saline infusion.
References
Monnet X, Teboul JL. Assessment of volume responsiveness during mechanical ventilation: recent advances. Critical Care 2013; 17:217.
