How do we Administer Fluids in the ICU?
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 2,304
- 试验地点
- 1
- 主要终点
- Number of patients in whom functional hemodynamic variables are used to indicate fluid challenge.
研究概览
简要总结
Fluids are one of most common therapies used in critically ill patients. Fluids are the cornerstone of hemodynamic management. In overt bleeding, fluids are often given without guidance with specific haemodynamic monitoring. In other conditions when hypovolemia may be more subtle or when the response to fluids is more variable, fluids are often given in a more titrable way, monitoring their haemodynamic impact. This practice, called the fluid challenge technique has been proposed by Max Harry Weil more than 30 years ago [1].
The fluid challenge has been used in several papers and studies assessing the response of patients to fluids. The way this practice is performed varies in terms of type of fluid, volume of fluid, rate of fluid administration, and clinical endpoints used.
There is no data that describe how fluid challenges are administered in ICU's across the world. Understanding this will provide valuable information regarding current practice and would be a basis for improving current practice and future research.
The way fluids are administered vary widely. Indications for fluids and monitoring of the effects are not standardized and may thus lead to heterogeneity in practice. In addition, several patients may fail to respond to fluids. The purpose of this observational study is to evaluate how fluids are administered and to identify the factors associated with a positive response to fluids. Better characterizing these practices and the patients who benefit from fluids would set the basis of further interventional trials trying to optimize fluid administration.
What does this study involve?
- All patients enrolled in the study will receive standard clinical care
- Data will be collected in order to study how fluid challenges are performed in ICU's
- No extra tests will be performed for this study
- Only measurements and data available as part of clinical practice will be collected
详细描述
Introduction
Fluid Administration in Critically Ill Patients.
Fluids are one of most common therapies used in critically ill patients. Fluids are the cornerstone of hemodynamic management. In overt bleeding, fluids are often given without guidance with specific haemodynamic monitoring. In other conditions when hypovolemia may be more subtle or when the response to fluids is more variable, fluids are often given in a more titrable way, monitoring their haemodynamic impact. This practice, called the fluid challenge technique has been proposed by Max Harry Weil more than 30 years ago [1].
Fluids have beneficial impact on outcome, especially in the context of hemodynamic optimization. Haemodynamic optimization has been shown to improve patient outcome when applied in the perioperative period and in the early phases of septic shock [2,3]. On the other hand, a positive fluid balance is associated with a poor outcome [4,5], but this may just reflect patient severity. In patients with respiratory failure, once hemodynamically stable, fluid restriction is associated with earlier separation from mechanical ventilation [4]. Altogether, it seems reasonable to give just the amount of fluids needed when the patients is hemodynamically unstable and to restrict fluids when the patient is stabilized. Such an approach seems associated with better outcomes [6].
The fluid challenge has been used in several papers and studies assessing the response of patients to fluids. The way this practice is performed varies in terms of:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All consecutive adult (18 years old and above) patients , up to a maximum of 20, in whom a fluid challenge is performed during a one week period will be included
排除标准
- •1/ Patient already included in the trial
- •2/ Overt bleeding Patients younger than 18 year
结局指标
主要结局
Number of patients in whom functional hemodynamic variables are used to indicate fluid challenge.
时间窗: 1 week
次要结局
- Number of patients responding to fluids, number of patients presenting contra-indication to functional hemodynamic variables.(one week)
研究者
Guy FRANCOIS
ESICM Trials Group
European Society of Intensive Care Medicine