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Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units

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Abstract

Purpose

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.

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Acknowledgments

Additional contributors to the PREVER Study Group: Olivier Baudin, Sylvie Calvat, Christophe Cracco, Charles Lafon, Stéphane Rouleau (Angoulême, CRICS group); Julien Pascal, Matthieu Jabaudon, Renaud Guérin, Sophie Cayot, Jean-Michel Constantin (Clermont-Ferrand); Damien Roux, Sylvain Jean-Baptiste, Clément Leclaire, Karim Ben Ahmed, Jonathan Messika Jean-Damien Ricard, Didier Dreyfuss, Louis-Marie Dumont, Camille Lhotte, Pauline Balagny, Julia Attali, Sonia Ayllon-Milla (Colombes); Aihem Yehia, Konstantinos Bachoumas, Gwenhael Colin, Maud Fiancette, Jean Claude Lacherade, Matthieu Henry Lagarrigue, Christine Lebert, Laurent Martin-Lefèvre, Jean Reignier, Isabelle Vinatier, (La Roche Sur Yon, CRICS group); Olivier Lesieur (La Rochelle); Marc Clavel, Nicolas Pichon, Bruno François, Emmanuelle Begot, Anne-Laure Fedou, Thomas Daix, Roxana Donisanu, Bénédicte Durgueil, Céline Gonzalez, Tiffany Duvoid (Limoges, CRICS group); Patrick Bardou, Michel Bonnivard, Anne Marco, Jérôme Roustan, Sylvie Vimeux (Montauban, CRICS group); Matthieu Conseil, Samir Jaber, Guillaume Rao, Daniel Verzilli (Department of Critical Care Medicine and Anesthesiology, Montpellier); Philippe Corne, Gilles Vincent (Department of Intensive Care Medicine, Montpellier); Laurent Brisard, Patrick Michel, Sophie Pajot, Pierre-André Rodie-Talbere, Nelly Rondeau (Nantes); François Barbier, Dalila Benzekri-Lefevre, Nicolas Bercault, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Isabelle Runge (Orléans, CRICS group); Romain Sonneville (Bichat, Paris); Alain Cariou, Fabrice Daviaud, Tristan Morichau-Beauchant (Cochin, Paris); René Robert, Jean-Pierre Frat, Delphine Chatellier, Anne Veinstein, Rémy Coudroy (Poitiers, CRICS group); Michel Grinand, Jérome Hoff, François Labadie, Pierre-Antoine Mielcarek, Paul Morin-Longuet, Freddy Thibaut (Saint-Nazaire); Asaêl Berger, Alexandra Boivin, Laure Stiel (Strasbourg, CRICS group);Nicolas Boussekey, Pierre-Yves Delannoy, Hugues Georges, Olivier Leroy, Agnès Meybeck, Damien Thellier (Tourcoing); Laetitia Bodet-Contentin, Denis Garot, Antoine Guillon, Aurélie Joret, Annick Legras, Claire Lhommet, Julie Mankikian, Emmanuelle Mercier, Emmanuelle Rouve (Tours, CRICS group);.

Conflicts of interest

The authors declare they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Medical-Surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d’Orléans, BP 6709, 45067, Orleans Cedex, France

    Thierry Boulain

  2. Medical Intensive Care Unit, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France

    Julie Boisrame-Helms & Ferhat Meziani

  3. Medical Intensive Care Unit, University Hospital, Tours, France

    Stephan Ehrmann & Pierre-François Dequin

  4. Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France

    Jean-Baptiste Lascarrou

  5. Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France

    Adrien Bouglé

  6. Intensive Care and Infectious Disease Unit, Hôpital Dron, Tourcoing, France

    Arnaud Chiche

  7. Réanimation Chirurgicale Polyvalente, Service d’Anesthésie-Réanimation, Hôpital Laennec, University Hospital, Nantes, France

    Karim Lakhal

  8. Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France

    Stéphane Gaudry

  9. General Intensive Care Unit, Hôpital Estaing, Centre Hospitalier Universitaire, Clermont-Ferrand, France

    Sébastien Perbet

  10. Medical-Surgical Intensive Care Unit, District Hospital Center, Angoulême, France

    Arnaud Desachy

  11. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France

    Séverin Cabasson

  12. Medical Intensive Care Unit, University Hospital, Poitiers, France

    Isabelle Geneau

  13. Intensive Care Unit, District Hospital Center, Saint Nazaire, France

    Patricia Courouble

  14. Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France

    Noémie Clavieras

  15. Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France

    Pablo L. Massanet

  16. Medical-Surgical Intensive Care Unit, District Hospital Center, Montauban, France

    Frédéric Bellec

  17. Intensive Care Unit, Alpes-Leman District Hospital Center, Contamine sur Arve, France

    Yoan Falquet

  18. Service de Réanimation Médicale et Infectieuse, Hôpital Bichat-Claude-Bernard, AP-HP, Université Paris Diderot, Paris, France

    François Réminiac

  19. Medical-Surgical Intensive Care Unit, University Hospital, University of Limoges, Limoges, France

    Philippe Vignon

  20. Sorbonne Paris Cité, ECEVE, UMRS 1123, Université Paris Diderot, Paris, France

    Stéphane Gaudry

  21. ECEVE, U1123, INSERM, 75010, Paris, France

    Stéphane Gaudry

  22. INSERM CIC1435, Limoges, France

    Philippe Vignon

Authors
  1. Thierry Boulain
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  2. Julie Boisrame-Helms
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  3. Stephan Ehrmann
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  4. Jean-Baptiste Lascarrou
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  5. Adrien Bouglé
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  6. Arnaud Chiche
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  7. Karim Lakhal
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  8. Stéphane Gaudry
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  9. Sébastien Perbet
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  10. Arnaud Desachy
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  11. Séverin Cabasson
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  12. Isabelle Geneau
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  13. Patricia Courouble
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  14. Noémie Clavieras
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  15. Pablo L. Massanet
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  16. Frédéric Bellec
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  17. Yoan Falquet
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  18. François Réminiac
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  19. Philippe Vignon
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  20. Pierre-François Dequin
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  21. Ferhat Meziani
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Corresponding author

Correspondence to Thierry Boulain.

Additional information

Take-home message:

Modalities of volume expansion in shocked patients were highly variable in French intensive care units. Overall the use of any kind of haemodynamic assessment to help decide and guide fluid bolus administration was infrequent.

For the Clinical Research in Intensive Care and Sepsis Group, Tours, France (http://www.crics.fr/en/) and for the PREVER study investigators.

The PREVER study investigators are listed in the Acknowledgment section.

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Boulain, T., Boisrame-Helms, J., Ehrmann, S. et al. Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units. Intensive Care Med 41, 248–256 (2015). https://doi.org/10.1007/s00134-014-3576-1

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  • DOI: https://doi.org/10.1007/s00134-014-3576-1

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