PURPOSE: To describe the current practices of volume expansion in French intensive care units (ICU). METHODS: In 19 ICUs, we prospectively observed the prescription and monitoring practices of volume expansion in consecutive adult patients with shock [sustained hypotension and/or need of vasopressor therapy, associated with at least tachycardia and/or sign (s) of hypoperfusion]. Patients were included at the time of prescription of the first fluid bolus (FB). Thereafter, all the FBs administered during the 96 h following shock onset were surveyed. An FB was defined as an intravenous bolus of at least 100 ml of a blood volume expander intended to rapidly improve the patient's circulatory condition. RESULTS: We included 777 patients [age: 63 ± 15 years; female gender: 274 (35 %); simplified acute physiology score II: 55.9 ± 20.6; ICU length of stay: 6 days (interquartile range (IQR) 3-13); ICU mortality: 32.8 %] and surveyed 2,694 FBs. At enrolment mean arterial pressure was 63 mmHg (IQR 55-71). The most frequent triggers of FB were hypotension, low urine output, tachycardia, skin mottling and hyperlactataemia. Amount of fluid given at each FB was highly variable between centres. Crystalloids were used in 91 % (2,394/2,635) and synthetic colloids in 3.3 % (87/2,635) of FBs. Overall, clinicians used any kind of haemodynamic assessment (central venous pressure measurement, predictive indices of fluid responsiveness, echocardiography, cardiac output monitoring or a combination of these) in 23.6 % (635/2,694) of all FBs surveyed, with an important between-centre heterogeneity. CONCLUSIONS: High between-centre variability characterised all the aspects of FB prescription and monitoring, but overall haemodynamic exploration to help guide and monitor FB was infrequent.
PURPOSE: To describe the current practices of volume expansion in French intensive care units (ICU). METHODS: In 19 ICUs, we prospectively observed the prescription and monitoring practices of volume expansion in consecutive adult patients with shock [sustained hypotension and/or need of vasopressor therapy, associated with at least tachycardia and/or sign (s) of hypoperfusion]. Patients were included at the time of prescription of the first fluid bolus (FB). Thereafter, all the FBs administered during the 96 h following shock onset were surveyed. An FB was defined as an intravenous bolus of at least 100 ml of a blood volume expander intended to rapidly improve the patient's circulatory condition. RESULTS: We included 777 patients [age: 63 ± 15 years; female gender: 274 (35 %); simplified acute physiology score II: 55.9 ± 20.6; ICU length of stay: 6 days (interquartile range (IQR) 3-13); ICU mortality: 32.8 %] and surveyed 2,694 FBs. At enrolment mean arterial pressure was 63 mmHg (IQR 55-71). The most frequent triggers of FB were hypotension, low urine output, tachycardia, skin mottling and hyperlactataemia. Amount of fluid given at each FB was highly variable between centres. Crystalloids were used in 91 % (2,394/2,635) and synthetic colloids in 3.3 % (87/2,635) of FBs. Overall, clinicians used any kind of haemodynamic assessment (central venous pressure measurement, predictive indices of fluid responsiveness, echocardiography, cardiac output monitoring or a combination of these) in 23.6 % (635/2,694) of all FBs surveyed, with an important between-centre heterogeneity. CONCLUSIONS: High between-centre variability characterised all the aspects of FB prescription and monitoring, but overall haemodynamic exploration to help guide and monitor FB was infrequent.
Authors: J Melot; M Sebbane; G Dingemans; P G Claret; E Arbouet; B Barkat; P Jamet; P Kovalevsky; B Louart; A Moreau; H Mourou; L Ortega; N Randriamamonjy; T Vandercamere; J-J Eledjam; J-E de La Coussaye; P Fabbro Peray; J-Y Lefrant; L Muller Journal: Ann Fr Anesth Reanim Date: 2012-07-03
Authors: Herbert P Wiedemann; Arthur P Wheeler; Gordon R Bernard; B Taylor Thompson; Douglas Hayden; Ben deBoisblanc; Alfred F Connors; R Duncan Hite; Andrea L Harabin Journal: N Engl J Med Date: 2006-05-21 Impact factor: 91.245
Authors: John A Myburgh; Simon Finfer; Rinaldo Bellomo; Laurent Billot; Alan Cass; David Gattas; Parisa Glass; Jeffrey Lipman; Bette Liu; Colin McArthur; Shay McGuinness; Dorrilyn Rajbhandari; Colman B Taylor; Steven A R Webb Journal: N Engl J Med Date: 2012-10-17 Impact factor: 91.245
Authors: Xavier Monnet; Mario Rienzo; David Osman; Nadia Anguel; Christian Richard; Michael R Pinsky; Jean-Louis Teboul Journal: Crit Care Med Date: 2006-05 Impact factor: 7.598
Authors: Simon Finfer; Bette Liu; Colman Taylor; Rinaldo Bellomo; Laurent Billot; Deborah Cook; Bin Du; Colin McArthur; John Myburgh Journal: Crit Care Date: 2010-10-15 Impact factor: 9.097
Authors: Scott L Weiss; Luke Keele; Fran Balamuth; Neika Vendetti; Rachael Ross; Julie C Fitzgerald; Jeffrey S Gerber Journal: J Pediatr Date: 2017-01-04 Impact factor: 4.406
Authors: Anders Perner; John Prowle; Michael Joannidis; Paul Young; Peter B Hjortrup; Ville Pettilä Journal: Intensive Care Med Date: 2017-05-03 Impact factor: 17.440
Authors: Maurizio Cecconi; Christoph Hofer; Jean-Louis Teboul; Ville Pettila; Erika Wilkman; Zsolt Molnar; Giorgio Della Rocca; Cesar Aldecoa; Antonio Artigas; Sameer Jog; Michael Sander; Claudia Spies; Jean-Yves Lefrant; Daniel De Backer Journal: Intensive Care Med Date: 2015-07-11 Impact factor: 17.440