TY - JOUR
T1 - Fluid challenges in intensive care: the FENICE study
T2 - A global inception cohort study
AU - Cecconi, Maurizio
AU - Hofer, Christoph
AU - Teboul, Jean-Louis
AU - Pettila, Ville
AU - Wilkman, Erika
AU - Molnar, Zsolt
AU - Della Rocca, Giorgio
AU - Aldecoa, Cesar
AU - Artigas, Antonio
AU - Jog, Sameer
AU - Sander, Michael
AU - Spies, Claudia
AU - Lefrant, Jean-Yves
AU - De Backer, Daniel
AU - FENICE Investigators
AU - ESCIM Trial Group
A2 - Novak, Ivan
A2 - Balik, Martin
A2 - Sturz, Pevel
A2 - Kratochvil, Milan
A2 - Bestle, Morten
A2 - Strange, Ditte Gry
A2 - Perner, Anders
A2 - Rasmussen, Bodil Steen
A2 - Hauge, Jacob
A2 - Meldgaard, Michael
PY - 2015
Y1 - 2015
N2 - BACKGROUND: Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.METHODS: This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.RESULTS: 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59%, CI 57-61%). In 43% (CI 41-45%) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36%, CI 34-37%). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22%, CI 20-24%). No safety variable for the FC was used in 72% (CI 70-74%) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.CONCLUSIONS: The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account.
AB - BACKGROUND: Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.METHODS: This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.RESULTS: 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59%, CI 57-61%). In 43% (CI 41-45%) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36%, CI 34-37%). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22%, CI 20-24%). No safety variable for the FC was used in 72% (CI 70-74%) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.CONCLUSIONS: The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account.
U2 - 10.1007/s00134-015-3850-x
DO - 10.1007/s00134-015-3850-x
M3 - Journal article
C2 - 26162676
SN - 0342-4642
VL - 41
SP - 1529
EP - 1537
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 9
ER -