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Integrated haemodynamic monitoring of fluid responsiveness and fluid tolerance in critical care: from physiology to bedside applications.

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Title: Integrated haemodynamic monitoring of fluid responsiveness and fluid tolerance in critical care: from physiology to bedside applications.
Authors: Mendes H; School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia. h.gomes_mendes@unsw.edu.au.; Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia. h.gomes_mendes@unsw.edu.au., Zentar M; School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.; Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia.
Source: Journal of clinical monitoring and computing [J Clin Monit Comput] 2026 Oct; Vol. 40 (5), pp. 1077-1089. Date of Electronic Publication: 2026 Jul 10.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: Springer Country of Publication: Netherlands NLM ID: 9806357 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-2614 (Electronic) Linking ISSN: 13871307 NLM ISO Abbreviation: J Clin Monit Comput Subsets: MEDLINE
Imprint Name(s): Publication: Amsterdam : Springer
Original Publication: Dordrecht, The Netherlands ; Boston : Kluwer Academic Publishers, c1998-
MeSH Terms: Critical Care*/methods , Hemodynamic Monitoring*/methods , Hemodynamic Monitoring*/instrumentation , Fluid Therapy*/methods , Hemodynamics*, Monitoring, Physiologic/methods ; Humans ; Cardiac Output ; Point-of-Care Systems ; Ultrasonography
Abstract: The framework of fluid responsiveness addresses only whether volume expansion will augment cardiac output, not whether the circulation can accept that volume without producing congestive organ injury. The complementary concept of fluid tolerance has accumulated empirical support over recent years and is integral to understanding patients' fluid status. This narrative review synthesises the physiological basis of fluid responsiveness and fluid tolerance, describes the bedside monitoring tools available to assess each, and considers the clinical implications of their joint interpretation in critical care. We performed a literature search restricted to articles published between 2020 and the date of the search. The retrieved abstracts were evaluated for relevance, and their reference lists were subsequently screened to identify additional pertinent publications. Fluid responsiveness and fluid tolerance are dissociable but physiologically interdependent, sharing determinants such as biventricular function, stressed volume and venous capacitance. Dynamic tests remain the preferred approach for assessing preload responsiveness; each has specific applicability conditions, and many require continuous or rapidly repeated cardiac output monitoring. Emerging tools have been developed to assess fluid tolerance, primarily based on vascular sonography; their interpretation requires concurrent assessment of biventricular function and further validation. Reframing fluid stewardship around the interaction between responsiveness and tolerance shifts the focus from forward-flow alone to net physiological benefit. No single parameter or device fully captures fluid status. An integrated, serial, multi-parametric assessment supported by appropriate monitoring platforms is therefore preferable to reliance on any single measure. At present, these tools support fluid stewardship rather than representing interventions with independently proven survival benefit. Future priorities include defining organ-specific congestion thresholds and testing whether monitoring-informed protocols improve outcomes.
(© 2026. The Author(s).)
Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: Not applicable; no human or animal participants were involved in this narrative review. Consent to participate: Not applicable. Consent for publication: Not applicable.
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Crit Care. 2025 Nov 4;29(1):472. (PMID: 41188936)
Crit Care. 2024 Oct 22;28(1):339. (PMID: 39439007)
Intensive Care Med. 2023 Jul;49(7):868-870. (PMID: 37294343)
Crit Care Med. 2026 Apr 1;54(4):725-812. (PMID: 41869847)
JAMA. 2016 Sep 27;316(12):1298-309. (PMID: 27673307)
Crit Care. 2017 Jun 19;21(1):147. (PMID: 28625165)
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Contributed Indexing: Keywords: Fluid responsiveness; Fluid tolerance; Haemodynamic monitoring; Monitoring platforms; Point-of-care ultrasound; Venous excess ultrasound
Entry Date(s): Date Created: 20260710 Date Completed: 20260910 Latest Revision: 20260913
Update Code: 20260913
PubMed Central ID: PMC13562101
DOI: 10.1007/s10877-026-01467-3
PMID: 42430050
Database: MEDLINE
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  Data: Integrated haemodynamic monitoring of fluid responsiveness and fluid tolerance in critical care: from physiology to bedside applications.
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  Data: The framework of fluid responsiveness addresses only whether volume expansion will augment cardiac output, not whether the circulation can accept that volume without producing congestive organ injury. The complementary concept of fluid tolerance has accumulated empirical support over recent years and is integral to understanding patients' fluid status. This narrative review synthesises the physiological basis of fluid responsiveness and fluid tolerance, describes the bedside monitoring tools available to assess each, and considers the clinical implications of their joint interpretation in critical care. We performed a literature search restricted to articles published between 2020 and the date of the search. The retrieved abstracts were evaluated for relevance, and their reference lists were subsequently screened to identify additional pertinent publications. Fluid responsiveness and fluid tolerance are dissociable but physiologically interdependent, sharing determinants such as biventricular function, stressed volume and venous capacitance. Dynamic tests remain the preferred approach for assessing preload responsiveness; each has specific applicability conditions, and many require continuous or rapidly repeated cardiac output monitoring. Emerging tools have been developed to assess fluid tolerance, primarily based on vascular sonography; their interpretation requires concurrent assessment of biventricular function and further validation. Reframing fluid stewardship around the interaction between responsiveness and tolerance shifts the focus from forward-flow alone to net physiological benefit. No single parameter or device fully captures fluid status. An integrated, serial, multi-parametric assessment supported by appropriate monitoring platforms is therefore preferable to reliance on any single measure. At present, these tools support fluid stewardship rather than representing interventions with independently proven survival benefit. Future priorities include defining organ-specific congestion thresholds and testing whether monitoring-informed protocols improve outcomes.<br /> (© 2026. The Author(s).)
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  Label: Competing Interests
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  Data: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: Not applicable; no human or animal participants were involved in this narrative review. Consent to participate: Not applicable. Consent for publication: Not applicable.
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  Label: References
  Group: RefInfo
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  Data: <i>Keywords: </i>Fluid responsiveness; Fluid tolerance; Haemodynamic monitoring; Monitoring platforms; Point-of-care ultrasound; Venous excess ultrasound
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  Data: <i>Date Created: </i>20260710 <i>Date Completed: </i>20260910 <i>Latest Revision: </i>20260913
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  Data: 10.1007/s10877-026-01467-3
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  Data: 42430050
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42430050
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      – Type: doi
        Value: 10.1007/s10877-026-01467-3
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      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: 1077
    Subjects:
      – SubjectFull: Monitoring, Physiologic methods
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Cardiac Output
        Type: general
      – SubjectFull: Point-of-Care Systems
        Type: general
      – SubjectFull: Ultrasonography
        Type: general
      – SubjectFull: Critical Care methods
        Type: general
      – SubjectFull: Hemodynamic Monitoring methods
        Type: general
      – SubjectFull: Hemodynamic Monitoring instrumentation
        Type: general
      – SubjectFull: Fluid Therapy methods
        Type: general
      – SubjectFull: Hemodynamics
        Type: general
    Titles:
      – TitleFull: Integrated haemodynamic monitoring of fluid responsiveness and fluid tolerance in critical care: from physiology to bedside applications.
        Type: main
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      – PersonEntity:
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            NameFull: Mendes H
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            NameFull: Zentar M
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          Dates:
            – D: 01
              M: 10
              Text: 2026 Oct
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1573-2614
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              Value: 40
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Journal of clinical monitoring and computing
              Type: main
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