Fluid Intake in Critically Ill Patients: The “Save Useless Fluids For Intensive Resuscitation” Multicenter Prospective Cohort Study
Frédérique Schortgen
(1)
,
Cécilia Tabra Osorio
(1)
,
Dorothée Carpentier
(2)
,
Matthieu Henry
(3)
,
Pascal Beuret
(4)
,
Guillaume Lacave
(5)
,
Georges Simon
(6)
,
Pierre-Yves Blanchard
(7)
,
Tiphanie Gobe
(8)
,
Antoine Guillon
(9)
,
Laurent Bitker
(10)
,
Guillaume Duhommet
(11)
,
Jean-Pierre Quenot
(12)
,
Matthieu Le Meur
(13)
,
Sébastien Jochmans
(14)
,
Fabrice Dubouloz
(15)
,
Nolwenn Mainguy
(16)
,
Josselin Saletes
(17)
,
Thibault Creutin
(18)
,
Pierre Nicolas
(19)
,
Julien Senay
(20)
,
Anne-Lise Berthelot
(21)
,
Delphine Rizk
(22)
,
David Tran Van
(23)
,
Audrey Riviere
(24)
,
Sarah Beatrice Heili-Frades
(25)
,
Justine Nunes
(26)
,
Nadine Robquin
(27)
,
Sylvie Lhotellier
(28)
,
Stanislas Ledochowski
(29)
,
Armelle Guénégou-Arnoux
(30, 31, 32)
,
Adrien Constan
(1)
1
CHIC -
Centre Hospitalier Intercommunal de Créteil
2 CHU Rouen
3 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
4 Centre Hospitalier de Roanne
5 CHV - Centre Hospitalier de Versailles André Mignot
6 Centre hospitalier de Troyes
7 CHU Tenon [AP-HP]
8 Hôpital Sud [CHU Rennes]
9 CHU Trousseau [Tours]
10 HCL - Hospices Civils de Lyon
11 CHPC - CH Centre Hospitalier Public du Cotentin
12 CHU Dijon
13 Groupe Hospitalier Nord Essonne [Longjumeau]
14 GHSIF - Groupe Hospitalier Sud Ile-de-France
15 TIMONE - Hôpital de la Timone [CHU - APHM]
16 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
17 Centre Hospitalier Le Mans (CH Le Mans)
18 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
19 Hôpital la Tronche
20 Hôpital Foch [Suresnes]
21 CH Cholet - Centre Hospitalier de Cholet
22 CHU Pitié-Salpêtrière [AP-HP]
23 Hôpital d'Instruction des Armées Robert Picqué
24 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
25 Health Foundation of Madrid
26 Centre Hospitalier Sud Francilien
27 CHIV - Centre Hospitalier Intercommunal Villeneuve-Saint-Georges
28 HUS - Les Hôpitaux Universitaires de Strasbourg
29 Groupe hospitalier nord [Bourgoin-Jallieu]
30 HeKA - Health data- and model- driven Knowledge Acquisition
31 CIC 1418 - CIC - HEGP
32 Service d’Épidémiologie et de Recherche Clinique [CHU HEGP]
2 CHU Rouen
3 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
4 Centre Hospitalier de Roanne
5 CHV - Centre Hospitalier de Versailles André Mignot
6 Centre hospitalier de Troyes
7 CHU Tenon [AP-HP]
8 Hôpital Sud [CHU Rennes]
9 CHU Trousseau [Tours]
10 HCL - Hospices Civils de Lyon
11 CHPC - CH Centre Hospitalier Public du Cotentin
12 CHU Dijon
13 Groupe Hospitalier Nord Essonne [Longjumeau]
14 GHSIF - Groupe Hospitalier Sud Ile-de-France
15 TIMONE - Hôpital de la Timone [CHU - APHM]
16 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
17 Centre Hospitalier Le Mans (CH Le Mans)
18 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
19 Hôpital la Tronche
20 Hôpital Foch [Suresnes]
21 CH Cholet - Centre Hospitalier de Cholet
22 CHU Pitié-Salpêtrière [AP-HP]
23 Hôpital d'Instruction des Armées Robert Picqué
24 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
25 Health Foundation of Madrid
26 Centre Hospitalier Sud Francilien
27 CHIV - Centre Hospitalier Intercommunal Villeneuve-Saint-Georges
28 HUS - Les Hôpitaux Universitaires de Strasbourg
29 Groupe hospitalier nord [Bourgoin-Jallieu]
30 HeKA - Health data- and model- driven Knowledge Acquisition
31 CIC 1418 - CIC - HEGP
32 Service d’Épidémiologie et de Recherche Clinique [CHU HEGP]
Résumé
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.