Q What is the current evidence for using stroke volume optimization rather than central venous pressure and urine output for fluid management?

A Thomas Ahrens, RN, PhD, CCNS, replies:

This question is easy to answer. Little evidence supports the use of central venous pressure (CVP) and urine output to guide fluid therapy, but a large body of evidence supports use of stroke volume optimization. A little background will illustrate why stroke volume optimization should be the predominant method used when giving fluids.

The assessment of volume status (eg, hypovolemia) is a major problem in the perioperative setting and in intensive care units. Because of care-givers’ inability to accurately assess the severity of hypovolemia and the patient’s response to treatment, patients are often misdiagnosed and do not receive the proper treatment. The results are delays in treatment, undertreatment, and overtreatment, all of which lead...

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