Fluid Tolerance: A Field Guide for the Bedside Clinician

The concept of fluid tolerance was recently introduced by our group. Here we review the major organ systems affected by potential venous congestion (cardiovascular, pulmonary, abdominal, renal, central nervous system and dermal tissue) as well as the pathophysiological findings that may lead them to be more vulnerable to detrimental effects of overzealous fluid administration. We thus propose an organ system-based framework for clinicians to assess their patient’s fluid tolerance by different means ranging from the traditional physical examination to the more invasive and technology-based methods. Hopefully this can lead to further study and eventual validation of a fluid tolerance score.