Abstract
It is extremely important and difficult to evaluate pre-load accurately in critically ill patients. Recently, a number of studies have reported that dynamic indicators help predict the hemodynamic responses to a fluid challenge better than static indicators. Further, high accuracy of these indicators have attracted considerable attention. Stroke volume variation (SVV), which is one of the dynamic indicators, is a reliable predictor of fluid responsiveness, and hemodynamic management with SVV possibly prevents over-load of volume fluid challenge and makes adequate administration of fluid therapy possible. It is extremely difficult to treat severe acute respiratory distress syndrome (ARDS) that develops during fluid resuscitation in the treatment of various conditions such as sepsis. Recently, extravascular lung water (EVLW) has been shown to be a prognostic indicator in patients with ARDS, and fluid management after measuring EVLW may possibly be beneficial in the treatment of ARDS. Herein, we discuss the possibility of developing goal-directed fluid therapy with both SVV and EVLW measurements for treating severe ARDS.
