title: Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units.
abstract: OBJECTIVE
  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.affiliation: Medical-Surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, 45067, Orleans Cedex, France, thierry.boulain@chr-orleans.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Boulain
authors.forename: Julie
authors.initials: J
authors.lastname: Boisrame-Helms
authors.forename: Stephan
authors.initials: S
authors.lastname: Ehrmann
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lascarrou
authors.forename: Adrien
authors.initials: A
authors.lastname: Bouglé
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiche
authors.forename: Karim
authors.initials: K
authors.lastname: Lakhal
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Desachy
authors.forename: Séverin
authors.initials: S
authors.lastname: Cabasson
authors.forename: Isabelle
authors.initials: I
authors.lastname: Geneau
authors.forename: Patricia
authors.initials: P
authors.lastname: Courouble
authors.forename: Noémie
authors.initials: N
authors.lastname: Clavieras
authors.forename: Pablo L
authors.initials: PL
authors.lastname: Massanet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bellec
authors.forename: Yoan
authors.initials: Y
authors.lastname: Falquet
authors.forename: François
authors.initials: F
authors.lastname: Réminiac
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Dequin
authors.forename: Ferhat
authors.initials: F
authors.lastname: Meziani
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012769:Shock / Q000188:drug therapy*
chemical_list: D010952:Plasma Substitutes