Meeting report of the 2nd International Fluid Academy Day. Part 1: results of the survey on the knowledge on fluid management
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AuthorsVeronique Brabers, Patrick Verburgh, Pieter-Jan Hotkens, Ester Philipse, Jelke Devos, Charlotte Van De Kerkhove, Johan Huygh, Brecht De Tavernier, Katrijn Van de Vijver, Niels Van Regenmortel, Dirk Himpe, Inneke De Laet, Karen Schoonheydt, Hilde Dits, etc
Fluid management in the critically ill has been neglected in the past. Many questions with regard to the type of fluids, the timing and the dosing remain unanswered. Recent data suggest that fluids should be treated as any other type of medication with indications, contraindications and adverse effects when used incorrectly.
The objective of this survey was to assess the awareness and current knowledge on fluid management among critical care physicians attending the 2nd international fluid academy day (iFAD) meeting.
A 21-item knowledge questionnaire was shown electronically to the participants of the 2nd iFAD held in Antwerp (Belgium) on November 17th in 2012. Each question was shown before the lecture covering the topic under study. The same questions were repeated at the end of the iFAD meeting to see whether a learning curve could be observed. Results from the two votings were compared. This paper reports on the results of the first part of the questionnaire including 10 knowledge questions on medical fluids and fluid management. Besides answering the knowledge questions respondents also provided information on their country of residence, basic speciality and years of experience. Participants of the conference voluntarily completed the survey via a voting system and the answers were recorded automatically and exported to an Excel worksheet. Statistical analysis was performed with SPSS software.
The 300 distributed voting pads were actively used by 241 (80.3%) of the second iFAD participants during the conference day. The respondents resided in the following countries: Belgium 38.6%, The Netherlands 13.3%, United Kingdom 7.1 %, Germany 7.9%, France 5.0%, and 28.2% came from other countries. The distribution of their primary speciality was: anaesthesiology 37.8%, intensive care medicine 29.0%, emergency medicine 7.5%, internal medicine 16.2%, surgery 3.7% while 5.8% were not a doctor. With regard to the years of experience in the ICU, 32.0% answered to be in training, 9.5% had 1 to 5 years of experience, 19.5% between 5 and 15 and 32.8% stated to have more than 15 years experience, finally 5.8% answered not to be active as a doctor. About 20% of the respondents said to have attended last year's first iFAD (n=53). The average overall score on the 10 knowledge questions on fluids and fluid management after the first vote was 23.2±15.7% vs 39.3±20.7% on the second vote (p=0.011). The best score on the first vote was for participants coming from Spain with 26.4±18 o/o and those from Russia having the worst (20.0±12%). On the second vote this was respectively Poland (44.3±28.2%) and again Russia (32.0±13.0%). Surprisingly, people not working as a doctor had the best scores (although the numbers were small), 31.4±16% on the first and 46.4±21.0% on the second vote (p=0.021).Also surprisingly, surgeons had the best scores, 26.7±14.l o/o on the first vote, 42.2±17.9% on the second vote (p=0.044), and again this may have been related to the small numbers. People who attended the first iFAD had better scores than those who did not with 27±14.8% vs 22.2±15.8% respectively on the first vote (p<0.001), and 48.1±20.0% vs 36.8±20.4% respectively on the second vote (p<0.001).
There is a general lack of knowledge on fluids and fluid management. Since correct fluid management and early intervention with goal directed therapy but also late conservative fluid management can reduce morbidity and mortality in critically ill patients, further educational efforts should be directed towards improving this knowledge. This can be done by organising state of the art lectures and evaluating the acquired knowledge with a voting system.