Posted this thread to get other people’s viewpoints on this. I have trouble convincing some of my colleagues that in the shocked, cold patient with a grossly distended right ventricle and septal flattening (presumed acute rather than chronic) that volume removal will improve hemodynamics. They cite the fear of “dropping the preload” too much.
To be clear I don’t advocate volume removal in other situations eg LV failure, diastolic dysfunction or RV failure without massive dilatation or that is chronic. In these situations I think sometimes optimal CO is at an elevated EDV/EDP.
Keen to hear more experienced peoples thoughts on this. We’re talking of course about the cold shocked pt.
To be clear I don’t advocate volume removal in other situations eg LV failure, diastolic dysfunction or RV failure without massive dilatation or that is chronic. In these situations I think sometimes optimal CO is at an elevated EDV/EDP.
Keen to hear more experienced peoples thoughts on this. We’re talking of course about the cold shocked pt.