Sébastien Preau1, Florent Dewavrin2, Vincent Demaeght3, Arnaud Chiche4, Benoît Voisin5, Franck Minacori6, Julien Poissy7, Claire Boulle-Geronimi8, Caroline Blazejewski9, Thierry Onimus10, Alain Durocher11, Fabienne Saulnier12. 1. Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: seb.preau@gmail.com. 2. Intensive Care Unit, General Hospital of Valenciennes, 59300 Valenciennes, France. Electronic address: dewavrin-f@ch-valenciennes.fr. 3. Intensive Care Unit, General Hospital of Valenciennes, 59300 Valenciennes, France. Electronic address: vincent.demaeght@yahoo.fr. 4. Intensive Care Unit, General Hospital of Tourcoing, 59200 Tourcoing, France. Electronic address: achiche@ch-tourcoing.fr. 5. Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: benoit59@gmail.com. 6. Intensive Care Unit, University Hospital of Lomme, 59160 Lomme, France. Electronic address: minacori.franck@ghicl.net. 7. Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: julien.poissy@chru-lille.fr. 8. Intensive Care Unit, General Hospital of Douai, 59500 Douai, France. Electronic address: claire.boulle@ch-douai.fr. 9. Intensive Care Unit, Salengro Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: caroline.blazejewski@chru-lille.fr. 10. Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: thierry.onimus@chru-lille.fr. 11. Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: alain.durocher@chru-lille.fr. 12. Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: fabienne.saulnier@chru-lille.fr.
Abstract
OBJECTIVE: The aim of the present study was to determine the use of static and dynamic haemodynamic parameters for predicting fluid responsiveness prior to volume expansion (VE) in intensive care unit (ICU) patients with systemic inflammatory response syndrome (SIRS). METHODS: We conducted a prospective, multicentre, observational study in 6 French ICUs in 2012. ICU physicians were audited concerning their use of static and dynamic haemodynamic parameters before each VE performed in patients with SIRS for 6 consecutive weeks. RESULTS: The median volume of the 566 VEs administered to patients with SIRS was 1000mL [500-1000mL]. Although at least one static or dynamic haemodynamic parameter was measurable before 99% (95% CI, 99%-100%) of VEs, at least one them was used in only 38% (95% CI, 34%-42%) of cases: static parameters in 11% of cases (95% CI, 10%-12%) and dynamic parameters in 32% (95% CI, 30%-34%). Static parameters were never used when uninterpretable. For 15% of VEs (95% CI, 12%-18%), a dynamic parameter was measured in the presence of contraindications. Among dynamic parameters, respiratory variations in arterial pulse pressure (PPV) and passive leg raising (PLR) were measurable and interpretable before 17% and 90% of VEs, respectively. CONCLUSIONS: Haemodynamic parameters are underused for predicting fluid responsiveness in current practice. In contrast to static parameters, dynamic parameters are often incorrectly used in the presence of contraindications. PLR is more frequently valid than PPV for predicting fluid responsiveness in ICU patients.
OBJECTIVE: The aim of the present study was to determine the use of static and dynamic haemodynamic parameters for predicting fluid responsiveness prior to volume expansion (VE) in intensive care unit (ICU) patients with systemic inflammatory response syndrome (SIRS). METHODS: We conducted a prospective, multicentre, observational study in 6 French ICUs in 2012. ICU physicians were audited concerning their use of static and dynamic haemodynamic parameters before each VE performed in patients with SIRS for 6 consecutive weeks. RESULTS: The median volume of the 566 VEs administered to patients with SIRS was 1000mL [500-1000mL]. Although at least one static or dynamic haemodynamic parameter was measurable before 99% (95% CI, 99%-100%) of VEs, at least one them was used in only 38% (95% CI, 34%-42%) of cases: static parameters in 11% of cases (95% CI, 10%-12%) and dynamic parameters in 32% (95% CI, 30%-34%). Static parameters were never used when uninterpretable. For 15% of VEs (95% CI, 12%-18%), a dynamic parameter was measured in the presence of contraindications. Among dynamic parameters, respiratory variations in arterial pulse pressure (PPV) and passive leg raising (PLR) were measurable and interpretable before 17% and 90% of VEs, respectively. CONCLUSIONS: Haemodynamic parameters are underused for predicting fluid responsiveness in current practice. In contrast to static parameters, dynamic parameters are often incorrectly used in the presence of contraindications. PLR is more frequently valid than PPV for predicting fluid responsiveness in ICU patients.
Authors: William Toppen; Elizabeth Aquije Montoya; Stephanie Ong; Daniela Markovic; Yuhan Kao; Xueqing Xu; Alan Chiem; Maxime Cannesson; David Berlin; Igor Barjaktarevic Journal: J Intensive Care Med Date: 2018-12-20 Impact factor: 3.510
Authors: Sandra Funcke; Michael Sander; Matthias S Goepfert; Heinrich Groesdonk; Matthias Heringlake; Jan Hirsch; Stefan Kluge; Claus Krenn; Marco Maggiorini; Patrick Meybohm; Cornelie Salzwedel; Bernd Saugel; Gudrun Wagenpfeil; Stefan Wagenpfeil; Daniel A Reuter Journal: Ann Intensive Care Date: 2016-05-31 Impact factor: 6.925