How to measure and interpret volumetric measures of preload.

Purpose of review To update the situation over the past few years on the clinical application of volumetric measures of preload in critically ill patients. Recent findings Cardiac filling pressures monitoring is unreliable for assessing cardiac preload in mechanically ventilated critically ill patients. The transpulmonary dilution indicator technique was shown to better identify preload than pulmonary arterial catheterization. Measuring static preload index as intrathoracic blood volume or global end diastolic volume provides a good preload index, either in experimental or in different clinical settings. Summary Volumetric measures of preload are good preload indexes. These data are to be interpreted together with the clinical patient’s condition, conventional hemodynamic data and the course of illness in critically ill patients. In order to evaluate whether the application of a predefined therapy algorithm based on volumetric monitoring can improve patients’ outcome, more studies are needed.