Intravascular volume expansion is a common intervention in critically ill patients with acute circulatory failure.we test the hypothesis that a mini-bolus fluid challenge, of either 50 ml , can predict fluid responsiveness in spontaneously breathing patients with hemodynamic instability.
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Eligibility Criteria
Inclusion Criteria:
* Patients with spontaneous breathing
* Patients in whom a fluid challenge is indicated because they present acute circulatory failure (which is defined as systolic blood pressure less than 90 mmHg or the need for vasopressors (norepinephrine more than 0.1 µg/kg/min) to maintain…
Inclusion Criteria:
* Patients with spontaneous breathing
* Patients in whom a fluid challenge is indicated because they present acute circulatory failure (which is defined as systolic blood pressure less than 90 mmHg or the need for vasopressors (norepinephrine more than 0.1 µg/kg/min) to maintain a systolic blood pressure more than 90 mmHg (14), and at least one sign of inadequate tissue perfusion:
* urine output of below 0.5ml/kg per hour over 1 hour
* tachycardia (heart rate of greater than 100 beats per minute)
* mottled skin.
* lactate \> 2 mmol/l
Exclusion Criteria:
* Cardiac arrest
* Acute respiratory distress syndrome
* Coma Glasgow Scale \< 14
* Age of less than 18 years
* Moribund patients
* Pregnant patients
* impossibility to perform passive leg raising (PLR) (trauma patients, lower extremity amputees, and prone patients)
* Patients with cardiac arrhythmias
* Patients with cardiogenic pulmonary oedema
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