Fluid Responsiveness Testing

Procedures & Monitoring · ICU Decoded chapter 83 · Free in full

Cited to Fluid responsiveness consensus.

Key points

The most reliable bedside test of fluid responsiveness is a passive leg raise with a cardiac output change ≥10%.
Controlled ventilation, regular rhythm, and VT ≥8 are required before pulse pressure or stroke volume variation mean anything.
IVC collapsibility is less reliable than PLR; stop fluids once the patient is not responsive.
Perform a fluid challenge as 250–500 mL over 10–20 min, measuring before and after.
If VT <8, use a tidal-volume challenge (PPV rise ≥3.5% predicts responsiveness); the 15-s end-expiratory occlusion test (≥5% CO rise) works even in arrhythmia; PPV 9–13% is a grey zone — use PLR there.

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