Elizabeth Bridges' "Using Functional Hemodynamic Indicators to Guide Fluid Therapy" (May) is an excellent reference. We cannot assume, however, that newer nurses will know that these numbers cannot be used in a vacuum. Treatment decisions take into account factors including age and chronic disease, and these factors merit some mention.

Carlene Boisaubin, RN

New York

Author Elizabeth Bridges responds: I agree that other factors need to be considered when interpreting physiological data. The key question to ask when using functional hemodynamic data is: does the patient have an indication of hypoperfusion?

If so, the next question is whether fluid administration is the appropriate treatment. The functional hemodynamic data can assist with this decision.

However, being a fluid responder doesn't mean the patient should receive fluids. There must be an indication of hypoperfusion or another reason to administer fluids.

Additionally, when other factors, such as right heart failure and cardiac arrhythmias, are present, these indicators should not be used to determine if a patient should receive fluids.