Meeting report of the First International Fluid Academy Day Part 2: Results of the survey on the knowledge of hemodynamic monitoring and fluid responsiveness
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AuthorsManu L. N. G. Malbrain, Niels Van Regenmortel, Dirk Himpe
Although the use of less invasive hemodynamic monitoring with either calibrated or uncalibrated techniques is steadily increasing in the ICU, many questions with regard to the different techniques, their indications and pitfalls remain unanswered. Recent data suggest that perioperative optimisation and goal directed therapy guided by hemodynamic monitoring could improve outcome.
To assess the awareness and current knowledge on hemodynamic monitoring among critical care physicians.
A 14-item knowledge questionnaire was shown electronically to the participants of the 1" international fluid academy day (iFAD) held in Antwerp (Belgium) on November 19th in 2011. 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 compared. This paper reports on the results of the second part of the questionnaire including 7 knowledge questions on hemodynamic monitoring. 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.
One hundred fifty nine (80%) of the 200 distributed voting pads among the 274 first iFAD participants were actively used during the conference day. The average overall score on the 7 knowledge questions on hemodynamic monitoring after the first vote was 25.4±22.2% vs 43.1±25.6% after the second vote (p<0.0001). The best score after the first vote was for United Kingdom with 32.9±24.4% and Germany having the worst (19.4±12.8%). After the second vote this was again the United Kingdom (49±26.8%) and again Germany (35.4±26.4%). Residents in training had the best score 31±24.9% after the first while those with 1 to 5 years of experience had the best score 49.2±26.6% after the second vote (p<0.0001). Intensivists had the best score after the first vote with 35.5±23.4% and also performed best after the second vote 55.5±24.6%.
There is general lack of knowledge on hemodynamic monitoring and assessment of preload and fluid responsiveness. 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 the knowledge on hemodynamic monitoring to guide this fluid management. This can be done by organising state of the art lectures and evaluating acquired knowledge with a voting system.