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

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

Population and distribution of beavers Castor fiber

1. A century ago, overhunting had reduced Eurasian beaver Castor fiber populations to c. 1200 animals in scattered refugia from France to Mongolia. Reintroductions and natural spread have since restored the species to large areas of its original range. Population has more than tripled since the first modern estimate in 1998; the minimum estimate is now c. 1.5 million. 2. Range expansion 2000–2020 has been rapid, with large extensions in western and south-central Europe, southern Russia, and west and central Siberia. Beavers are now re-established in all countries of their former European range except for Portugal, Italy, and the southern Balkans; they occur broadly across Siberia to Mongolia, with scattered populations father east. About half of the world population lives in Russia. Populations appear to be mature in much of European Russia, Belarus, the Baltic States, and Poland. 3. There is a significant population of North American beaver Castor canadensis in Finland and north-west Russia. Most other 20th-Century introductions of this species have become extinct or been removed. 4. Recent DNA studies have improved understanding of Castor fiber population prehistory and history. Two clades, east and west, are extant; a third ‘Danube’ clade is extinct. Refugial populations were strongly bottlenecked, with loss of genetic diversity through genetic drift. 5. Future range extension, and large increases in populations and in impacts on freshwater systems, can be expected. Beavers are now recolonising densely populated, intensely modified, low-relief regions, such as England, the Netherlands, Belgium, and north-west Germany. They will become much more common and widespread there in coming decades. As beavers are ecosystem engineers with profound effects on riparian habitats, attention to integrating beaver management into these landscapes using experience gained in other areas – before the rapid increase in population densities and impacts occurs – is recommended. beaver, Castor fiber, Castor canadensis, distribution, Eurasia, population, reintroductionpublishedVersio