Fluid responsiveness and venous congestion: unraveling the nuances of fluid status

Excerpt

The concept of fluid tolerance, which refers to the capacity of patients to undergo fluid expansion without experiencing harmful effects of volume overload with organ dysfunction, is gaining recognition in both intensive care literature [1] and clinical practice, driven by the mounting evidence of the detrimental impacts of fluid overload [2]. It physiologically makes sense that systemic venous return can still increase even when some degree of venous congestion is already present. In the past, Patterson and Starling reported a transition phase before fluid-induced right ventricular (RV) failure, where increasing RV inflow increased RV outflow despite slightly elevated right atrial pressure (RAP) and a RV functioning above its normal unstressed volume [3]. …