GDFT Algorithm
Potential
Goal Directed Fluid Therapy
Algorithm
Stroke Volume Variation (SVV)
Intubated and Mechanically Ventilated
Of course these are just monitors with inherent limitations and failures:
Always use clinical judgement!
Know Limitations to monitor use!
Know artifacts in stroke volume variation calculations (SVV)!
Playing with a monitor is no excuse to delay treatment--
Timely reversal of hypoperfusion!
If Hypotension and
Stroke Volume Variation (SVV) > 13%
SVV > 13% suggest might be fluid responsive
Do a Fluid challenge
[Diagnostic and Therapeutic]
Fluid Challenge
250 ml crystalloid bolus (over < 5 minutes)
(or 500 ml crystalloid bolus over < 10 minutes)
(LR—not NS)
[Consider albumin (or blood) if indicated]
Normal Saline Risks Hyperchloremic Acidosis
If Fluid Responsive
(get reduction in SVV)
Give additional Fluid bolus until Goals met:
Resolution of hypotension or
No longer fluid responsive—
(SVV not reduced with fluid challenge)
(or SVV < 13%)
If Not Fluid Responsive
And Hypotensive
(SVV < 13%)
or
(SVV not reduced with fluid challenge)
—start inotropes for low cardiac index
(Cardiac index < 2.5 L/min)
Ephedrine bolus or norepinephrine drip
or
Consider phenylephrine for
hypotension,
and not fluid responsive,
and normal Cardiac Index
Particularly with epidural catheter sympathetic block
Based (in part) upon Thiele Univ. of Virginia 2015 p. 433
Limitations
Algorithm based upon intubated and positive pressure ventilation.
Originally studied with tidal volume > 8 ml/kg.
["Protective Lung Ventilation" is 6 to 8 ml/kg ideal body weight].
Other Limitations
Open Thorax
Irregular Heart Rhythm
High Abdominal Pressures
