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Multicenter Study
. 2024 Feb 1;52(2):258-267.
doi: 10.1097/CCM.0000000000006091. Epub 2023 Nov 1.

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   11   12 , Guillaume Duhommet  13 , Jean-Pierre Quenot  14   15   16 , Matthieu Le Meur  17 , Sébastien Jochmans  18 , Fabrice Dubouloz  19 , Nolwenn Mainguy  20 , Josselin Saletes  21 , Thibault Creutin  22 , Pierre Nicolas  23 , Julien Senay  24 , Anne-Lise Berthelot  25 , Delphine Rizk  26 , David Tran Van  27 , Audrey Riviere  28 , Sarah Beatrice Heili-Frades  29 , Justine Nunes  30 , Nadine Robquin  31 , Sylvie Lhotellier  32 , Stanislas Ledochowski  33 , Armelle Guénégou-Arnoux  34 , Adrien Constan  1 ; Save Useless Fluids For Intensive Resuscitation (SUFFIR) Study Group, Reseau European de Recherche en Ventilation Artificielle (REVA) Network
Collaborators, Affiliations
Multicenter Study

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

Frédérique Schortgen et al. Crit Care Med. .

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.

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Conflict of interest statement

Dr. Constan’s institution received funding from the French Intensive Care Society/Société de Réanimation de Langue Française. Dr. Senay disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

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