Septic patient with abdominal catastrophe and hepatic failure receives high doses of noradrenaline (2mg/hour). The dosage of noradrenaline has been increased due to repeated drops in BP with no effect. PiCCO shows high EVLWI (extravascular lung water index). You cannot use dynamic parameters of preload obtained by PiCCO since the patient breaths spontaneously.
Let´s suppose you perform TTE; however, the patient is hard to examine (imaging is possible only from the point between the apex and subxiphoid region):