Meeting report of the 2nd International Fluid Academy Day. Part 3: results of the survey amongst critical care physicians on the knowledge of fluid management, hemodynamic and organ function monitoring
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AuthorsBrecht De Tavernier, Veronique Brabers, Charlotte Van De Kerkhove, Niels Van Regenmortel, Dirk Himpe, Inneke De Laet, Karen Schoonheydt, Hilde Dits, Manu L. N. G. Malbrain
Fluid management in the critically ill has been neglected for way too long and although the use of invasive and less invasive hemodynamic monitoring is steadily increasing in the ICU, many questions remain unanswered. Recent data suggest that fluids should be dealt with as any other type of medication and that perioperative optimisation and goal directed therapy guided by hemodynamic monitoring could improve outcome. Furthermore, new devices have become available to assess other organ functions, which, in combination with serum biomarkers could help the clinician with decision making.
To assess the awareness and current knowledge on fluid management and hemodynamic and organ function monitoring 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 international fluid academy day (iFAD) held on Saturday November 17th 2012 in Antwerp ("Radisson SAS Hotel Congress and Convention Centre", Antwerp, Belgium). Each question was shown before the lecture covering the topic under study. The same questions were repeated at the end of the iFAD to see whether a learning curve could be observed. Results from the two voting sessions were then compared. This paper reports on the global results of both parts of the questionnaire including knowledge questions (KQ) on fluid management, fluid responsiveness, hemodynamic and other organ function monitoring, totalling 10 KQ's on fluid management and 11 KQ's on organ function monitoring. The respondents also provided information on their country of residence, basic speciality and years of experience. Participants of the conference voluntarily completed the survey on the 21 knowledge questions via a voting system and the answers were recorded automatically and exported to an Excel worksheet. Statistical analysis was performed with SPSS software (version 17.0.l;SPSS, Chicago, IL, USA). A subgroup of respondents (n=89) also filled in a paper survey with 20 general questions, 4 questions on demographics, 8 questions on fluid management and 8 questions on organ function monitoring.
Two hundred forty one (80.3%) of the 300 distributed voting pads among the 401 second iFAD participants were actively used during the conference day. The average overall score on the 21 knowledge questions on fluid management, fluid responsiveness, hemodynamic and organ function monitoring after the first vote was 20.4±13.8% vs 37.9±22.4% after the second vote (p<0.0001). Fifty three (20.7%) of the 241 voters also participated in the first iFAD meeting in 2011. The best score after the first vote was for Germany (that scored worst in the 2011 iFAD congress!), with a score of26.3±14.0% after the first round and 43.7±12.8% after the second round. Russia had the worst score with 16.0±10.8% after the first round and 30.0%±18.4% after the second round. Although not statistically significant, residents in training had the best score with 21.8±14.3% after the first vote and also after the second vote with 41.0±24.2%, very closely followed by the intensivists with 5-15 years of experience (ANOVA, p=NS). Interestingly, the 14 people reporting 'not being a doctor' scored the best with 24.3±15.2% during the first round. Doctors reporting internal primedicine as their basic speciality training scored the best with 21.7±14.4%, closely followed by the emergency physicians. Surgeons scored the worst during the first round (18.9%±11.7). Also after the second vote, internal medicine specialists scored best with a total score of 41.7±23.0% and anaesthesiologists and intensivists scored worst but with only small, non-significant differences (ANOVA, p=NS). Not surprisingly, the bigger the ICU in which intensivists worked, the better the scores. The results of the subgroup of respondents (n=89) that also filled in a paper survey with general questions will also be reported herein. Conclusions With a global knowledge score of 20.4±13.8% after the first vote versus 37.9±22.4% after the second vote this survey confirms that there is a general lack of knowledge on fluid management, hemodynamic monitoring and assessment of preload parameters, fluid responsiveness and other organ function monitoring techniques. Since correct fluid management and early intervention with goal directed therapy to support end-organ function can reduce morbidity and mortality in critically ill patients, further educational efforts should be directed towards improving the knowledge on organ function monitoring to optimize and guide fluid management, and this is exactly the main purpose of the 3rd International Fluid Academy Days in 2013.