Medical-Surgical Intensive Care Unit, Hôpital de La Source, Centre Hospitalier Régional d'Orléans, BP 6709, 45067, Orleans Cedex, France,
Intensive Care Med. 2015 Feb;41(2):248-56. doi: 10.1007/s00134-014-3576-1. Epub 2014 Dec 2.
To describe the current practices of volume expansion in French intensive care units (ICU).
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.
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.
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.
描述法国重症监护病房（ICU）中容量扩充的当前实践情况。
在 19 个 ICU 中，我们前瞻性观察了连续休克成年患者（持续低血压和/或需要血管加压治疗，伴有至少心动过速和/或灌注不足迹象）容量扩充的处方和监测实践。患者在首次给予液体冲击量（FB）时被纳入研究。此后，对休克发生后 96 小时内给予的所有 FB 进行了调查。FB 定义为旨在迅速改善患者循环状况的至少 100 ml 血容量扩充剂的静脉推注。
我们纳入了 777 例患者[年龄：63 ± 15 岁；女性：274 例（35%）；简化急性生理学评分 II：55.9 ± 20.6；ICU 住院时间：6 天（中位数（IQR）3-13）；ICU 死亡率：32.8%]，并调查了 2694 例 FB。入组时平均动脉压为 63 mmHg（IQR 55-71）。FB 的最常见触发因素为低血压、少尿、心动过速、皮肤斑驳和高乳酸血症。每个 FB 给予的液体量在中心之间差异很大。晶体液在 91%（2394/2635）的 FB 中使用，合成胶体液在 3.3%（87/2635）的 FB 中使用。总体而言，临床医生在所有调查的 FB 中 23.6%（635/2694）使用了任何类型的血流动力学评估（中心静脉压测量、液体反应性预测指标、超声心动图、心输出量监测或这些方法的组合），不同中心之间存在很大差异。
FB 处方和监测的所有方面都存在高度的中心间变异性，但总体上很少使用血流动力学探索来指导和监测 FB。
