Positioning intensive care patients in Trendelenburg position to identify fluid responsiveness assessed by PiCCO device.

It is a prospective observational study. Patients admitted to Intensive Care Unit of University Clinical Centre of Gdańsk, receiving advanced hemodynamic monitoring with PiCCO method will be enrolled. After blood pressure measurement, PiCCO will be calibrated with transpulmonary thermodilution with 10 - 20 ml of cold saline. Readings will be noted. The patient will be positioned in Trendelenburg position with it's head 15 degrees down. The increase of blood pressure after positioning in relation to the values obtained before the trial will be correlated to the parameters that asses patent's volaemia. After 5 minutes patient will be back to supine position and hemodynamic parameters will be recorded for another 5 minute.

Inclusion Criteria:

• hemodynamic instability
• mechanical ventilation

Exclusion Criteria:

• increased intracranial pressure
• increased intraabdominal pressure
• lower limbs sequential compression system
• agitation
• patients exposed to pain stimulus before the test
• aortic aneurysm
• left to right cardiac shunt
• severe valvular insufficiency

Patients admitted to Intensive Care Unit of University Clinical Centre in Gdańsk