title: Variable assessment of the circulation in intensive care unit patients with shock.
abstract: BACKGROUND
  Circulatory failure is frequent in intensive care unit (ICU) patients and is associated with a high mortality and morbidity. There is no current consensus on which parameters best evaluate circulatory failure, and clinical practice regarding haemodynamic assessment is unknown. This study describes current clinical practice regarding circulatory assessment in ICU patients with shock.
  
  
  METHODS
  This was a prospective, observational cohort study conducted in a university hospital ICU over a four-month period. Doctors working in the ICU were divided into two groups: trainees and specialists. They registered their circulatory assessments of consecutive patients with shock. The parameters included type of shock, kind of parameters used (markers of hypoperfusion, hypovolaemia and flow), which parameter was considered to be most important and the clinical action taken.
  
  
  RESULTS
  A total of 23 doctors performed 210 patient assessments, which was equivalent to a median of eight (interquartile range: 5-14) per doctor. Trainees used six (5-8) parameters compared with five (3-6) parameters per assessment among specialists (p < 0.01). Mean arterial pressure (MAP) was the most frequently assessed parameter (n = 178) and both specialist (in 23% of assessments) and trainees (30%) considered MAP to be the most important parameter. Hypoperfusion markers were assessed in 99% of the cases, and a marker of hypovolaemia was also assessed in 83% (95% confidence interval (CI) 78-88) of these cases. Fluid was the most frequent clinical action taken, and was given after 150 assessments, but a marker of hypovolaemia was not assessed in 13% (95% CI 9-20) of these situations. Trainees assessed heart rate (76% versus 54%; p < 0.01), diastolic (45% versus 28%, p < 0.01) and systolic blood pressure (70% versus 46%; p < 0.01) and central venous oxygen saturation (63% versus 35%; p < 0.01) more frequently than specialists.
  
  
  CONCLUSIONS
  MAP was the most frequently used parameter and fluid the most frequently given treatment by ICU doctors assessing patients with shock. The study indicates that assessment of hypoperfusion leads to the use of a marker of hypovolaemia, but in some cases fluid was given without this assessment. The haemodynamic assessment differed between ICU specialists and trainees.
  
  
  BACKGROUND
  Righospitalet's Research Council supported the study.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark. louiseinkeri@gmail.com
authors.forename: Louise Inkeri
authors.initials: LI
authors.lastname: Hennings
authors.forename: Nicolai
authors.initials: N
authors.lastname: Haase
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D062186:Arterial Pressure; D002302:Cardiac Output; D002983:Clinical Competence; D003422:Critical Care; D004231:Diuresis; D005440:Fluid Therapy; D006339:Heart Rate; D006439:Hemodynamics; D006454:Hemoglobins / Q000378:metabolism; D006785:Hospitals, University; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis / Q000628:therapy; D019344:Lactic Acid / Q000097:blood; D010100:Oxygen / Q000097:blood; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012769:Shock / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy
chemical_list: D006454:Hemoglobins; D019344:Lactic Acid; D010100:Oxygen