How to confirm a patient is well resuscitated after receiving Intravenous (IV) fluid resuscitation?

Confirming Adequate Resuscitation After IV Fluids

Among the options provided, CVP of 8 mmHg (Option A) is the only acceptable resuscitation target, though it should never be used in isolation to confirm adequate resuscitation. 1

Why Each Option Is or Isn't Adequate

Option A: CVP 8 mmHg - ACCEPTABLE BUT INSUFFICIENT ALONE

• CVP 8-12 mmHg is an established resuscitation target recommended by the Surviving Sepsis Campaign as part of protocolized quantitative resuscitation goals 1
• However, CVP alone poorly predicts whether additional fluids will improve cardiac output and should not be the sole indicator of adequate resuscitation 1, 2
• Dynamic measures of fluid responsiveness are superior to static measures like CVP for guiding ongoing fluid administration 1, 2

Option B: MAP 45 mmHg - INADEQUATE

• This MAP is dangerously low and indicates ongoing shock, not adequate resuscitation 1, 2
• Current guidelines universally recommend maintaining MAP ≥65 mmHg during resuscitation 1, 2
• A MAP of 45 mmHg requires immediate escalation of therapy with additional fluids and/or vasopressors 2

Option C: Urine Output 0.1 mL/kg/h - INADEQUATE

• This urine output is far below the threshold for adequate resuscitation 1, 3
• The guideline threshold for adequate resuscitation is urine output ≥0.5 mL/kg/hr for at least 2 hours, which indicates restored renal perfusion 1, 3
• Urine output of 0.1 mL/kg/h represents oliguria and signals inadequate tissue perfusion requiring intervention 3

Option D: Lactate = 2 mmol/L - BORDERLINE/ACCEPTABLE

• Lactate ≤2 mmol/L is considered within normal range and is an appropriate resuscitation target 1
• Lactate clearance toward normal range (≤2 mmol/L) within 24 hours is associated with improved survival 1
• Serial lactate measurements provide objective evaluation of response to therapy 1, 2
• However, up to 23% of septic patients have lactate ≥2 mmol/L with normal central venous oxygen saturation, representing "cryptic shock" 1

The Multiparametric Approach You Must Use

No single parameter definitively confirms adequate resuscitation—you must assess multiple endpoints simultaneously 1:

Hemodynamic Targets (All Must Be Met)

• CVP 8-12 mmHg 1
• MAP ≥65 mmHg 1, 2
• Central venous oxygen saturation ≥70% 1

Perfusion Markers

• Urine output ≥0.5 mL/kg/hr for at least 2 hours 1, 3
• Lactate normalization (≤2 mmol/L) within 24 hours 1, 2
• Capillary refill time ≤2 seconds 1, 3
• Normal mental status 1, 2
• Warm extremities without mottling 1, 3
• Palpable peripheral pulses 1, 2

Critical Pitfalls to Avoid

• Do not rely on blood pressure alone—patients can maintain normal blood pressure through compensatory mechanisms while experiencing significant tissue hypoperfusion 1
• Do not ignore elevated lactate in seemingly stable patients—this represents occult hypoperfusion requiring intervention 1
• Do not continue aggressive fluid resuscitation without reassessment—overresuscitation increases mortality and complications including abdominal compartment syndrome and coagulopathy 4, 1, 2
• Do not use CVP as the sole predictor of fluid responsiveness—while CVP 8-12 mmHg is a resuscitation target, it poorly predicts whether additional fluids will improve cardiac output 1, 2

Answer to Your Question

If forced to choose only one option from your list, Option A (CVP 8) is the only acceptable resuscitation target, though clinically inadequate when used alone. Option D (Lactate = 2) is also acceptable. Options B and C represent inadequate resuscitation requiring immediate intervention. 1, 2