SMACC Debate – Rob MacSweeney vs Paul Marik – Predicting Fluid Responsiveness is a Waste of Time

April 12, 2016 by Scott Weingart 7 Comments

Summary by: Roger Harris

Rob MacSweeney and Paul Marik debate whether the assessment of fluid responsiveness in the resuscitation of patients with shock a waste of time? Both Marik and MacSweeney agree that many of the traditional methods of assessing patients volume status are flawed and of no value. Marik goes on to argue that the only clinically meaningful outcome that we should measure in response to a fluid challenge is Stoke Volume. In at least 50% of patients there is no improvement in stroke volume and further treatment with fluid boluses will only likely cause harm. Marik goes on to argue that we must know where our patients are position on their Frank-Starling curve to predict whether they are fluid responsive and we can assess this with passive led raise.

See the Intensive Care Network Site for the Original Audio and Paul's Slides

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Scott Weingart

An ED Intensivist from NY. No conflicts of interest (coi).

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Cite this post as:

Scott Weingart. SMACC Debate – Rob MacSweeney vs Paul Marik – Predicting Fluid Responsiveness is a Waste of Time. EMCrit Blog. Published on April 12, 2016. Accessed on April 8th 2020. Available at [https://emcrit.org/emcrit/smacc-debate-rob-mac-sweeney-vs-paul-marik-predicting-fluid-responsiveness-waste-time/ ].

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Guest

Abbasi

The most important point here is: we know PLR predicts fluid responsiveness but does that mean we keep giving fluids until the pt is no longer fluid responsive? What evidence is there for that because as they mention in the talk we are all fluid responsive but that doesn’t mean we all need to be infused.

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