Background Fluid challenge (FC) is one of the most common practices in Intensive Care Unit (ICU). The present study aimed to evaluate whether echocardiographic assessment of the response to FC at the end of the infusion or 20 min later could affect the results of the FC. Methods This is a prospective, observational, multicenter study including all ICU patients in septic shock requiring a FC of 500 mL crystalloids over 10 min. Fluid responsiveness was defined as a > 15% increase in stroke volume (SV) assessed by velocity-time integral (VTI) measurements at baseline ( T 0 ), at the end of FC (T 10 ), then 10 (T 20 ) and 20 min (T 30 ) after the end of FC. Results From May 20, 2014, to January 7, 2016, a total of 143 patients were enrolled in 11 French ICUs (mean age 64 ± 14 years, median IGS II 53 [43–63], median SOFA score 10 [8–12]). Among the 76/143 (53%) patient responders to FC at T 10 , 37 patients were transient responders (TR), i.e., became non-responders (NR) at T 30 (49%, 95%CI = [37–60]), and 39 (51%, 95%CI = [38–62]) patients were persistent responders (PR), i.e., remained responders at T 30 . Among the 67 NR at T 10 , 4 became responders at T30, (6%, 95%CI = [1.9–15.3]). In the subgroup analysis, no statistical difference in hemodynamic and echocardiographic parameters was found between groups. Conclusions This study shows that 51.3% of initial responders have a persistent response to fluid 30 min after the beginning of fluid infusion and only 41.3% have a transient response highlighting that fluid responsiveness is time dependent. Trial registration ClinicalTrials.gov , NCT02116413 . Registered on April 16, 2014 Electronic supplementary material The online version of this article (10.1186/s13054-019-2448-z) contains supplementary material, which is available to authorized users.

Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.

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BACKGROUND: Carbohydrate intake during physical exercise improves muscle performance and decreases fatigue. We hypothesized that carbohydrate intake during labor, which is a period of significant physical activity, can decrease the instrumental vaginal delivery rate. METHODS: In a multicenter, prospective, randomized, controlled trial, healthy adult pregnant women presenting with spontaneous labor were assigned to a “Carbohydrate” group (advised to drink 200 mL of apple or grape juice without pulp every 3 hours) or a “Fasting” group (water only). The primary outcome was the instrumental vaginal delivery rate. Secondary outcomes included duration of labor, rate of cesarean delivery, evaluation of maternal hunger, thirst, stress, fatigue, and overall feeling during labor by numeric rating scale (0 worst rating to 10 best rating), rate of vomiting, and hospital length of stay. Statistical analysis was performed on an intention-to-treat basis. The primary outcome was tested with the “Fasting” group as the reference group. The P values for secondary outcomes were adjusted for multiple comparisons. The differences between groups are reported with 99% confidence interval (CI). RESULTS: A total of 3984 women were analyzed (2014 in the Carbohydrate group and 1970 in the Fasting group). There was no difference in the rate of instrumental delivery between the Carbohydrate (21.0%) and the Fasting (22.4%) groups (difference, −1.4%; 99% CI, −4.9 to 2.2). No differences were found between the Carbohydrate and the Fasting groups for the duration of labor (difference, −7 minutes; 99% CI, −25 to 11), the rate of cesarean delivery (difference, −0.3%; 99% CI, −2.4 to 3.0), the rate of vomiting (difference, 2.8%; 99% CI, 0.2–5.7), the degree of self-reported fatigue (difference, 1; 99% CI, 0–2), self-reported hunger (difference, 0; 99% CI, −1 to 1), thirst (difference, 0; 99% CI, −1 to 1), stress (difference, 0; 99% CI, −1 to 1), overall feeling (difference, 0; 99% CI, 0–0), and the length of hospitalization (difference, 0; 99% CI, −1 to 0). CONCLUSIONS: Carbohydrate intake during labor did not modify the rate of instrumental vaginal delivery.