Fluid challenges in intensive care: the FENICE study: A global inception cohort study

Area of Science:

• Critical Care Medicine
• Hemodynamic Management
• Fluid Therapy

Background:

• Fluid challenges (FCs) are a cornerstone of hemodynamic management in intensive care units (ICUs).
• While beneficial, fluid therapy carries risks, and data on FC indications, type, amount, and rate are limited.
• Physician practices for FCs in critically ill patients are not well-defined.

Purpose of the Study:

• To evaluate the current practices of fluid challenges (FCs) in critically ill patients.
• To assess the indications, type, volume, and rate of fluid administration during FCs.
• To examine the variables used to trigger FCs and the impact of patient response on further fluid administration.

Main Methods:

• An international observational study was conducted in ICUs.
• A maximum of 20 patients undergoing one FC were enrolled per participating unit.
• Data from 2213 patients were analyzed.

Main Results:

• The median FC volume was 500 ml, administered over a median of 40-60 minutes.
• Hypotension was the primary indication for FC in 59% of cases.
• No hemodynamic variable was used in 43% of FCs, and safety variables were rarely employed (28%).
• Dynamic indices of fluid responsiveness were used in only 22% of cases.
• No significant difference in further fluid administration was observed based on FC response.

Conclusions:

• Current practices for fluid challenges in critically ill patients are highly variable.
• Routine prediction of fluid responsiveness and the use of safety limits during FCs are uncommon.
• Information from previous FCs is not consistently utilized in clinical decision-making.