Abstract
The Focused Rapid Echocardiographic Evaluation (FREE) is both an ultrasound exam and a style of resuscitation. It allows using fluid, vasoconstrictors, and inotropes together, personalized to the patient. It aims to optimize flow across the capillary beds by considering both arterial delivery and venous return. Treatment recommendations for fluid can change based on the strategy. Fluid-liberal strategies make sense early in shock, if there is clear evidence of end-organ hypoperfusion, and if severe respiratory failure is not a primary issue. Conversely fluid-conservative therapies are reasonable after the primary cause of shock has been addressed, and when severe respiratory failure is present. This chapter describes the resuscitation philosophy behind the FREE and how to select the correct fluid strategy. The following chapters discuss how to incorporate the strategy and echo to generate treatment recommendations.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- CO:
-
Cardiac output
- CVP:
-
Central venous pressure
- DO2:
-
Oxygen delivery
- FREE:
-
Focused Rapid Echocardiographic Evaluation
- HR :
-
Heart rate
- RAP:
-
Right atrial pressure
- SV:
-
Stroke volume
- SVR:
-
Systemic vascular resistance
- VR:
-
Volume responsiveness
Suggested Reading
Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80. https://doi.org/10.5603/AIT.2014.0060. PMID: 25432556
Murthi SB, Hess JR, Hess A, Stansbury LG, Scalea TM. Focused rapid echocardiographic evaluation versus vascular catheter-based assessment of cardiac output and function in critically ill trauma patients. J Trauma Acute Care Surg. 2012;72(5):1158–64. https://doi.org/10.1097/TA.0b013e31824d1112. PMID: 22673240
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Anderson, B., Murthi, S.B. (2021). Fluid Strategies in the FREE. In: Salerno, A., Haase, D.J., Murthi, S.B. (eds) Atlas of Critical Care Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-74687-2_25
Download citation
DOI: https://doi.org/10.1007/978-3-030-74687-2_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-74685-8
Online ISBN: 978-3-030-74687-2
eBook Packages: MedicineMedicine (R0)