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Intensive Care Med. 2015 Sep;41(9):1529-37. doi: 10.1007/s00134-015-3850-x. Epub 2015 Jul 11.

Fluid challenges in intensive care: the FENICE study: A global inception cohort study.

Collaborators (388)

Hofer C, Teboul JL, Teboul JL, Pettila V, Wilkman E, Molnar Z, Della Rocca G, Aldecoa C, Artigas A, Jog S, Sander M, Spies C, Lefrant JY, De Backer D, De Backer D, Jog S, De Backer D, Silva E, Zhang X, Ospina-Tascón G, Arias J, Gornik I, Benes J, Petersen A, Lefrant JY, Teboul JL, Spies C, Sander M, Zsolt M, della Rocca G, Sprung C, Koch M, Guttormsen AB, Tavares M, Pettilä V, Wilkman E, Mikaszewska-Sokolewicz M, Aldecoa C, Artigas A, Hofer C, Bakker J, Parke R, Kirov M, Wernerman J, Esen F, Cecconi M, Cannesson M, De Backer D, Cecconi M, De Backer D, Cecconi M, Hofer C, Pettila V, Molnar Z, Lefrant JY, Teboul JL, Njimi H, François G, Cueto G, Hockley S, Ambekar H, Laterre PF, Dujardin MF, Damas P, Deschamps P, Glorieux D, Hoste E, Miribung M, Devriendt J, Haentjens L, Biston P, Dugernier T, De Backer D, Bulpa P, Dive A, Debaveye Y, Franck S, Conde K, Morsch R, Ramos M, Dias F, Mataloun S, Mendes C, Silva F, Grion C, Knibel M, Yang C, Xiangyu Z, Cai G, Ortiz G, Ospina-Tascon G, Yepes D, Londono Arcila HF, Molina F, Pereira F, Sanchez-Galvez HF, Benitez F, Arias Ortiz J, Gonzalez Rojas M, Cavric G, Lukic E, Zykova I, Benes J, Freml P, Satinsky I, Suk P, Novak I, Balik M, Szturz P, Kratochvil M, Bestle M, Strange DG, Perner A, Rasmussen BS, Hauge J, Meldgaard M, Toome V, Wilkman E, Kuitunen A, Varila S, Hovilehto S, Pulkkinen A, Kiviniemi O, Tallgren M, Laitio R, Mongardon N, Dhonneur G, Malledant Y, Lepouse C, Darmon M, Mira JP, Chiche JD, Joannes-Boyau O, Preau S, Larche J, Mottard N, Lefrant JY, Bengler C, Teboul JL, Argaud L, Hamzaoui O, Desebbe O, Burtin P, Reignier J, Durand M, Guitard PG, Asfar P, Guillot M, Boulain T, Mekontso Dessap A, Ducrocq N, Lakhal K, Gregoire C, Schmauss M, Zacharowski K, Meybohm P, Treskatsch S, Bloos F, van Huelst S, Baumann H, Kersten A, Goldmann A, Gkiokas G, Dimoula A, Kofinas G, Anthopoulos G, Molnar Z, Pankotai B, Kopitko C, Gartner B, Schaffer E, Fulesdi B, Sarkany A, Jog S, Samavedam S, Shah B, Dixit S, Toraskar K, Nandakumar S, Goila AK, Nayyar A, Patel M, Mitra D, Jagiasi B, Jakkinaboina S, Goswami J, Ghosh S, Hashemian M, Mahmoodpoor A, Breen D, Benbenishty J, Kuniavsky M, Kolpak O, Castiglione G, Monti G, Molin A, Martucci G, Panarello G, Della Rocca G, Raineri SM, Pota V, Acquarolo A, Ploner F, Lapichino G, Lombardo A, Roasio A, Cardelino S, Pignataro A, Oggioni R, Mangani V, Parrini V, Spadaro S, Volta CA, Alampi D, Torrente S, Monastra L, Marini F, Mazzini P, Albanese D, Riccardi S, Ruberto F, Belluomo AC, Silvestri R, Citerio G, Brienza N, Brazzi L, Protti A, Bottino N, David A, Manzoni D, Foti G, Numis F, Morimatsu H, Shimizu K, Koch M, Munster L, Rai V, Buttigieg M, Pickkers P, Mijzen L, Kesecioglu J, Bakker J, Van Duijn D, Ormskerk P, Beck O, Parke R, Goodson J, King B, Koelle J, Kantor S, Gomez O, Ramos I, Mikaszewska-Sokolewicz M, Jedynak M, Sulkowski W, Adamik B, Chruscikowski M, Wadelek J, Korzybski J, Misiewska-Kaczur A, Piasecka-Twarog M, Fijaikowska A, Maciejewski D, Smiechowicz K, Milkowska E, Czerwinska A, Lukaszewska A, Wieczorek A, Czuczwar M, Czerwiec A, Tamowicz B, Branco V, Estilita J, Basilio C, Diogo C, Toma R, Bubenek-Turconi SI, Filipescu D, Popescu M, Titova J, Belskiy V, Smetkin A, Grigoryev E, Pugachev S, Gasenkampf A, Abouelala A, Almekhlafi G, Rupnik E, Garcia-Delgado H, Saez Fernandez A, Celaya Lopez M, Ramasco F, Planas K, Aldecoa C, Zavala E, De Nadal M, Picos SA, Fernandez S, Munoz A, Herrera Para L, Maseda E, Rovira A, Monge Garcia MI, Ferrer R, Sole Violan J, Garcia Nogales X, Torrents E, Ripolles Melchor J, Tomás Marsilla JI, Araujo Aguilar P, Aguilar G, Menor EM, Martinez MC, Leal Micharet AM, Ferri Riera C, Mosquera D, Astola I, Freita-Ramos S, Garcia Olivares P, Jimenez Bartolome MB, Fernandez Gonzalez I, Sanchez-Izquierdo JA, Arribas P, Gimenez-Esparzavich C, Anglada M, Martin S, Weerakoon RK, Wernerman J, Bendjelid K, Fumeaux T, Hofer C, Maggiorini M, Demirkiran O, Adanir T, Ergin Ozcan P, Kelebek Girgin N, Elahi N, Kashef S, Alsabbah A, Lowe A, Wise M, Vizcaychipi MP, Baht S, Webb S, Friis J, Boulanger C, Gratrix A, Harvey D, Ferguson A, Espie L, Toth-Tarsoly P, Lewis K, Shelley B, Thuerey J, Przemyslaw D, Ranganathan M, Hormis A, Spivey M, Henning J, Saveker R, Csabi P, Bland M, Barrera Groba C, Al-Subaie N, Thomson R, Hamilton M, Iannuccelli F, Roberts C, Sherwood N, Kasipandian V, Silversides J, Jonas A, Szakmany T, Vickers E, Richards J, Tham L, Williams D, Heenen S, Hobrok M, Walden A, Raj A, Bauer P, Kashyap R, Tolnai P, Kjelle BJ, Andersen FH, Palo JE, Namendys-Silva SA.

Author information

1
Anaesthesia and Intensive Care, St George's Hospital and Medical School, London, SW17 0QT, UK, mcecconi@sgul.ac.uk.

Abstract

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01787071.

PMID:
26162676
PMCID:
PMC4550653
DOI:
10.1007/s00134-015-3850-x
[Indexed for MEDLINE]
Free PMC Article

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