title: [Use of indicators of fluid responsiveness in septic shock: a survey in public emergency departments].
abstract: BACKGROUND
  Fluid therapy is one of the major elements of severe sepsis and septic shock management. A systematic initial fluid bolus is recommended before evaluation of left ventricular filling pressure by the use of indicators of fluid responsiveness, preferentially dynamic ones. A massive fluid therapy could be damaging for the patient. Dynamic indicators of fluid responsiveness are not often relevant in the emergency department. This study was aimed to evaluate the use of indicators of fluid responsiveness by emergency practitioners during septic shock management.
  
  
  METHODS
  Cross sectional survey using anonymous self-questionnaire.
  
  
  METHODS
  We included all practitioners working in public emergency department of Languedoc-Roussillon (France). Primary-end point was the use of one indicator of fluid responsiveness at least. Uni- and multivariate analysis was conducted to find associated factors.
  
  
  RESULTS
  Of 232 practitioners included, we collected 149 questionnaires (response rate=64%). Hundred and eight practitioners (72% [64-79%]) used at least one indicator of fluid responsiveness. Fifty-six practitioners (38% [30-46%]) used echocardiography, 54 practitioners (36% [29-44%]) used blood lactate concentration, 45 practitioners (30% [23-38%]) used passive leg raising. The use of indicators of fluid responsiveness is associated with easy access to echography device (odd ratio=2.94 [1.16-7.62], P=0.03).
  
  
  CONCLUSIONS
  Emergency practitioners use preferentially less invasive and less time-consuming indicators of fluid responsiveness.
authors: Service des urgences, pôle anesthésie-réanimation-douleur-urgence, CHU de Nîmes, France.
authors: J
authors: J
authors: Melot
authors: M
authors: M
authors: Sebbane
authors: G
authors: G
authors: Dingemans
authors: P G
authors: PG
authors: Claret
authors: E
authors: E
authors: Arbouet
authors: B
authors: B
authors: Barkat
authors: P
authors: P
authors: Jamet
authors: P
authors: P
authors: Kovalevsky
authors: B
authors: B
authors: Louart
authors: A
authors: A
authors: Moreau
authors: H
authors: H
authors: Mourou
authors: L
authors: L
authors: Ortega
authors: N
authors: N
authors: Randriamamonjy
authors: T
authors: T
authors: Vandercamere
authors: J-J
authors: JJ
authors: Eledjam
authors: J-E
authors: JE
authors: de La Coussaye
authors: P
authors: P
authors: Fabbro Peray
authors: J-Y
authors: JY
authors: Lefrant
authors: L
authors: L
authors: Muller
mesh_terms: D000328:Adult; D015415:Biomarkers; D001810:Blood Volume; D003102:Colloids / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D000077324:Crystalloid Solutions; D004452:Echocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D011187:Posture; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012772:Shock, Septic / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D007773:Lactates