Fluid Intake in Critically Ill Patients: The “Save Useless Fluids For Intensive Resuscitation” Multicenter Prospective Cohort Study*-Reference-Cited by-同舟云学术

Fluid Intake in Critically Ill Patients: The “Save Useless Fluids For Intensive Resuscitation” Multicenter Prospective Cohort Study*

Published:2023-11-01 Issue:2 Volume:52 Page:258-267
ISSN:0090-3493
Container-title:Critical Care Medicine
language:en
Short-container-title:

Author:

Schortgen Frédérique¹,Tabra Osorio Cécilia¹,Carpentier Dorothée²,Henry Matthieu³,Beuret Pascal⁴,Lacave Guillaume⁵,Simon Georges⁶,Blanchard Pierre-Yves⁷,Gobe Tiphanie⁸,Guillon Antoine⁹,Bitker Laurent¹⁰¹¹¹²,Duhommet Guillaume¹³,Quenot Jean-Pierre¹⁴¹⁵¹⁶,Le Meur Matthieu¹⁷,Jochmans Sébastien¹⁸,Dubouloz Fabrice¹⁹,Mainguy Nolwenn²⁰,Saletes Josselin²¹,Creutin Thibault²²,Nicolas Pierre²³,Senay Julien²⁴,Berthelot Anne-Lise²⁵,Rizk Delphine²⁶,Tran Van David²⁷,Riviere Audrey²⁸,Heili-Frades Sarah Beatrice²⁹,Nunes Justine³⁰,Robquin Nadine³¹,Lhotellier Sylvie³²,Ledochowski Stanislas³³,Guénégou-Arnoux Armelle³⁴,Constan Adrien¹,

Affiliation:

1. Réanimation et surveillance continue adulte, Centre hospitalier intercommunal, Créteil, France.

2. Department of Medical Intensive Care, Rouen University Hospital, Rouen, France.

3. Médecine Intensive Réanimation, Centre hospitalier départemental Vendée, La Roche-sur-Yon, France.

4. Réanimation et Soins continus, Centre Hospitalier, Roanne, France.

5. Réanimation médico-chirurgicale, Centre Hospitalier de Versailles, Le Chesnay, France.

6. Réanimation polyvalente, Centre hospitalier, Troyes, France.

7. Médecine Intensive et Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Paris, France.

8. Réanimation médicale, Centre Hospitalier Universitaire de Rennes—Hôpital Pontchaillou, Rennes, France.

9. Intensive Care Unit, Tours University Hospital, Research Center for Respiratory Diseases, INSERM U1100, University of Tours, Tours, France.

10. Médecine Intensive—Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.

11. Université Claude Bernard Lyon 1, Lyon, France.

12. Université Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1294, Villeurbanne, France.

13. Unité Réanimation Polyvalente, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France.

14. Department of Intensive Care, Burgundy University Hospital, Dijon, France.

15. Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.

16. INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.

17. Service de Réanimation, Groupe Hospitalier Nord Essonne, Longjumeau, France.

18. Service de Médecine Intensive—Réanimation et Unité de Recherche Clinique, Groupe Hospitalier Sud Ile-de-France, Melun, France.

19. Réanimation des urgences, Hôpitaux universitaires de Marseille Timone, Marseille, France.

20. Réanimation polyvalente, Centre hospitalier Bretagne Atlantique, Vannes, France.

21. Service de Réanimation Médico-Chirurgicale et USC, Centre hospitalier, Le Mans, France.

22. Service de médecine intensive-réanimation, Hôpitaux Universitaires APHP-Paris-Saclay, Le Kremlin-Bicêtre, France.

23. Médecine Intensive Réanimation, CHU Grenoble-Alpes, La Tronche, France.

24. Service de réanimation polyvalente, Hôpital Foch, Suresnes, France.

25. Service de réanimation polyvalente, Centre hospitalier, Cholet, France.

26. Service de Médecine Intensive—Réanimation, Groupe Hospitalier Pitié Salpêtrière APHP—Sorbonne Université, Paris, France.

27. Réanimation polyvalente, Hôpital d’Instruction des Armées Robert Picqué, Villenave d’Ornon, France.

28. Réanimation Polyvalente, CHU de La Réunion, Saint Pierre, France.

29. Intermediate Respiratory Care Unit, University Hospital Jiménez Díaz Quirón Health Foundation of Madrid, Madrid, Spain.

30. Réanimation adultes, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.

31. Médecine Intensive Réanimation, Centre hospitalier intercommunal, Villeneuve St Georges, France.

32. Réanimation—Hôpitaux universitaires, Strasbourg, France.

33. Réanimation polyvalente, Groupe hospitalier nord Dauphiné, Bourgoin-Jallieu, France.

34. Université Paris Cité, AP-HP, Hôpital européen Georges Pompidou, Unité de Recherche Clinique, Centre d’Investigation Clinique 1418 Épidémiologie Clinique, INSERM, Inria, HeKA, Paris, France.

Abstract

OBJECTIVES: Patients at risk of adverse effects related to positive fluid balance could benefit from fluid intake optimization. Less attention is paid to nonresuscitation fluids. We aim to evaluate the heterogeneity of fluid intake at the initial phase of resuscitation. DESIGN: Prospective multicenter cohort study. SETTING: Thirty ICUs across France and one in Spain. PATIENTS: Patients requiring vasopressors and/or invasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All fluids administered by vascular or enteral lines were recorded over 24 hours following admission and were classified in four main groups according to their predefined indication: fluids having a well-documented homeostasis goal (resuscitation fluids, rehydration, blood products, and nutrition), drug carriers, maintenance fluids, and fluids for technical needs. Models of regression were constructed to determine fluid intake predicted by patient characteristics. Centers were classified according to tertiles of fluid intake. The cohort included 296 patients. The median total volume of fluids was 3546 mL (interquartile range, 2441–4955 mL), with fluids indisputably required for body fluid homeostasis representing 36% of this total. Saline, glucose-containing high chloride crystalloids, and balanced crystalloids represented 43%, 27%, and 16% of total volume, respectively. Whatever the class of fluids, center of inclusion was the strongest factor associated with volumes. Compared with the first tertile, the difference between the volume predicted by patient characteristics and the volume given was +1.2 ± 2.0 L in tertile 2 and +3.0 ± 2.8 L in tertile 3. CONCLUSIONS: Fluids indisputably required for body fluid homeostasis represent the minority of fluid intake during the 24 hours after ICU admission. Center effect is the strongest factor associated with the volume of fluids. Heterogeneity in practices suggests that optimal strategies for volume and goals of common fluids administration need to be developed.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine

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