title: The use of static and dynamic haemodynamic parameters before volume expansion: A prospective observational study in six French intensive care units.
abstract: OBJECTIVE
  The aim of the present study was to determine the use of static and dynamic haemodynamic parameters for predicting fluid responsiveness prior to volume expansion (VE) in intensive care unit (ICU) patients with systemic inflammatory response syndrome (SIRS).
  
  
  METHODS
  We conducted a prospective, multicentre, observational study in 6 French ICUs in 2012. ICU physicians were audited concerning their use of static and dynamic haemodynamic parameters before each VE performed in patients with SIRS for 6 consecutive weeks.
  
  
  RESULTS
  The median volume of the 566 VEs administered to patients with SIRS was 1000mL [500-1000mL]. Although at least one static or dynamic haemodynamic parameter was measurable before 99% (95% CI, 99%-100%) of VEs, at least one them was used in only 38% (95% CI, 34%-42%) of cases: static parameters in 11% of cases (95% CI, 10%-12%) and dynamic parameters in 32% (95% CI, 30%-34%). Static parameters were never used when uninterpretable. For 15% of VEs (95% CI, 12%-18%), a dynamic parameter was measured in the presence of contraindications. Among dynamic parameters, respiratory variations in arterial pulse pressure (PPV) and passive leg raising (PLR) were measurable and interpretable before 17% and 90% of VEs, respectively.
  
  
  CONCLUSIONS
  Haemodynamic parameters are underused for predicting fluid responsiveness in current practice. In contrast to static parameters, dynamic parameters are often incorrectly used in the presence of contraindications. PLR is more frequently valid than PPV for predicting fluid responsiveness in ICU patients.
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: seb.preau@gmail.com.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Preau
authors.affiliation: Intensive Care Unit, General Hospital of Valenciennes, 59300 Valenciennes, France. Electronic address: dewavrin-f@ch-valenciennes.fr.
authors.forename: Florent
authors.initials: F
authors.lastname: Dewavrin
authors.affiliation: Intensive Care Unit, General Hospital of Valenciennes, 59300 Valenciennes, France. Electronic address: vincent.demaeght@yahoo.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Demaeght
authors.affiliation: Intensive Care Unit, General Hospital of Tourcoing, 59200 Tourcoing, France. Electronic address: achiche@ch-tourcoing.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiche
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: benoit59@gmail.com.
authors.forename: Benoît
authors.initials: B
authors.lastname: Voisin
authors.affiliation: Intensive Care Unit, University Hospital of Lomme, 59160 Lomme, France. Electronic address: minacori.franck@ghicl.net.
authors.forename: Franck
authors.initials: F
authors.lastname: Minacori
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: julien.poissy@chru-lille.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Poissy
authors.affiliation: Intensive Care Unit, General Hospital of Douai, 59500 Douai, France. Electronic address: claire.boulle@ch-douai.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Boulle-Geronimi
authors.affiliation: Intensive Care Unit, Salengro Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: caroline.blazejewski@chru-lille.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Blazejewski
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: thierry.onimus@chru-lille.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Onimus
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: alain.durocher@chru-lille.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000 Lille, France. Electronic address: fabienne.saulnier@chru-lille.fr.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Saulnier
mesh_terms: D001794:Blood Pressure; D001810:Blood Volume; D003422:Critical Care; D005440:Fluid Therapy / Q000379:methods* / Q000592:standards; D005602:France; D006439:Hemodynamics; D007362:Intensive Care Units; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012129:Respiratory Function Tests
chemical_list: D010952:Plasma Substitutes
keywords: Inflammation; Intensive care; Passive leg raising; Respiratory variations; SIRS; Sepsis; Systemic inflammatory response syndrome