Is there significant ongoing blood loss?
Are the filling pressures "Optimal" (not necessarily maximal) for this patient, as defined upon return from theatre?
The anaesthetist and the surgeon will give relevant detail of "optimal" CVP or PCWP responsiveness after chest closure. They will also give information on heart size and function.
Give and assess response to a fluid challenge (colloid 250 mls over 10-15 minutes)
A CVP or PCWP of 5 – 15 mmHg is acceptable.
Do not treat an isolated CVP or PCWP if all other cardiovascular parameters are acceptable.
PEEP may exaggerate the hypotension seen in hypovolaemic patients.
Patients may receive 1000 mls of colloid. No further fluid should be given beyond this limit without discussion with the Intensive Care Specialist.