title: Fluid challenges in intensive care: the FENICE study: A global inception cohort study.
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.
authors.affiliation: Anaesthesia and Intensive Care, St George's Hospital and Medical School, London, SW17 0QT, UK, mcecconi@sgul.ac.uk.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cecconi
authors.forename: Christoph
authors.initials: C
authors.lastname: Hofer
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.forename: Ville
authors.initials: V
authors.lastname: Pettila
authors.forename: Erika
authors.initials: E
authors.lastname: Wilkman
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Molnar
authors.forename: Giorgio
authors.initials: G
authors.lastname: Della Rocca
authors.forename: Cesar
authors.initials: C
authors.lastname: Aldecoa
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.forename: Sameer
authors.initials: S
authors.lastname: Jog
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
mesh_terms: D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'