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CME: New Trends in Hemodynamics: Dynamic Assessments

Activity Description / Statement of Need:


    -Hemodynamic Goals
    -Fluid Resuscitation
    -Historical Perspective
    -Fluid responsiveness and the 6 Guiding principles of fluid resuscitation
    -Techniques for assessment of fluid responsiveness
    -Static – CVP (PCWP)
    -Dangers of a high CVP
    -Heart-lung interactions
    -Passive leg raising
    -Fluid Challenge
    -Do I give fluid?
    -The effects of a fluid bolus are short lived


Goal-directed therapy (GDT) has been taken as the gospel in critical care since the publication of Rivers et al.’s seminal paper on the topic demonstrating a mortality benefit in patients with severe sepsis and related shock back in late 2001, whose protocols were soon embraced and became ensconced in practice as standards of care, overlapping with other, high-acuity areas of medical specialty like surgery and emergency medicine. However, these initially results later became more mixed and equivocal on the whole when balanced in the context of more recent literature.

Fluid balance is paramount, and indiscriminate administration of fluids, either too conservatively or too liberally, is associated with mortality and significant morbidity in a diverse array of patient populations, and conventional, one-size-fits all approaches to fluid management do a disservice to both medical and surgical patients with dynamic needs.

In this learning activity, Dr. Paul Marik, MD, FCCP, FCCM, discusses present techniques for assessing fluid responsiveness.

Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

This program is supported by Educational Grants from Cheetah Medical and Baxter Healthcare.

Release Date: December 09, 2019 -- Expiration Date: December 09, 2021

Faculty: Paul Marik, MD, FCCP, FCCM


Learning Objectives

By the end of the session the participant will be able to:

  • Describe the risks of over- and under-resuscitation
  • Describe the present methods of fluid assessment
  • Describe the present methods of hemodynamic monitoring
  • Given patient cases, reason your approach to fluid management under various clinical circumstances


This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosure and Resolution of COI

 As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved through  content review ScientiaCME.


Faculty Disclosure: Dr.  Paul Marik, MD discloses that he is a consultant / speaker for Baxter, Boehringer-Ingelheim, and Abbott Nutrition.

Disclosures of Educational Planner: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Commercial Support Disclosure: This program is supported by an educational grant from Cheetah Medical and Baxter Healthcare.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.