Anaesthesia and Critical Care with Technology

Fluid management is the centre of shock management, but only in the early phase of shock, your patient will finally not respond to your additive fluid by the end, at that time point, you will have to find more ways to augment your patient's haemodynamics.

Will the application of ultrasonography, the TOE, transoesophageal echocardiograph, will be another helpful equipment to help and guide your making decision. It will help you to differentiate your patient's CVS status. The diameter of great vein either Superior vena cava or Inferior vena cava is an index to demonstrate the dynamic haemodynamics monitoring parameter. If both vessels can be collapsed or compressible, SVC by the breathing from mandate breath by IPPV or IVC from abdominal pressure linked closely to intrathoracic pressure, it would mean that your patient will be improved after you give him/her more fluid. This is shown in the condition 1 and 2 where the SVC is difficult to orientate during inspiration phase, and the diameter is significantly smaller than the expired time. The SVC collapsibility and IVC collapsibility are essential dynamic haemodynamic parameter that will be helpful in the situation that you have to decide whether or not to give more fluid to your patient. If your patient has the condition 3, you give more fluid in, you are endangering your patient, because at this point, your patient does not need fluid loading any more, and he/she would not have fluid responsiveness either.