Fluid management...the four basic questions

When you think of fluid management In hemodynamic unstable patients, basically four functional questions need to be answered.

Because the primary goal of resuscitation is to secure tissue oxygenation, the first question is already the most decisive, but also the most difficult one:

Is tissue oxygenation adequate?
Because representative tissue oxygenation is not measurable directly, primarily three variables are used as surrogates: mixed venous oxygen saturation; central venous oxygenation; and serum lactate.In brief, none of them is able to detect tissue oxygen debt definitely, because every single one is influenced by various morbidities and drug interactions

The second question is: How can cardiac output (CO), as the main determinate of oxygen delivery, be improved? Or, better representing clinical matters: Is the patient volume responsive?

The third question regards the vasomotor tone: Is it increased, decreased, or normal in the hypotensive patient?

Fourth, heart work: Is the heart able to sustain an adequate CO when arterial pressure is restored without going into failure

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