Meeting report of the 2nd International Fluid Academy Day. Part 2: results of the survey on the knowledge on hemodynamic and organ function monitoring and fluid responsiveness
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Pieter-Jan Hotkens, Patrick Verburgh, Ester Philipse, Jelke Devos, Charlotte Van de Kerkhove, Katrijn Van de Vijver, Johan Huygh, Veronique Brabers, Brecht De Tavernier, Niels Van Regenmortel, Inneke De Laet, Karen Schoonheydt, Hilde Dits, Dirk Himpe, etc- Tags: cardiac output, central nervous system, fluid responsivenss, heart function, hepatic function, kidney function, knowledge, monitoring, respiratory function, survey, teaching, voting
Abstract/Text
Background
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. Furthermore over the last years many techniques have become available at the bedside for endorgan (heart, lungs, kidney, liver, brain, ... ) function monitoring
Objective
To assess the awareness and current knowledge on hemodynamic and organ function monitoring and fluid responsiveness among critical care physicians attending the 2nd international fluid academy day (iFAD) meeting.
Methods
A 21-item knowledge questionnaire was shown electronically to the participants of the 2nd international fluid academy day (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 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 11 knowledge questions (KQ11-KQ21) on hemodynamic and endorgan function monitoring and assessment of fluid responsiveness. 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 by means of 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).
Results
Two hundred forty one (80.3%) of the 300 distributed voting pads between the 401 second iFAD participants were actively used during the conference day. The average overall score on the 11 knowledge questions on hemodynamic monitoring after the first vote was 17.6±18% vs 36.6±28.1 % after the second vote (p<0.001). The best score after the first vote was for Germany with 28.4±19.5% and Russia having the worst ( 12± 17.9% ). After the second vote this was respectively Poland ( 48.6±28%) and again Russia having the worst score (28±30.3%). Residents in training had the best score 19.9±19.6% after the first and this was also the case after the second vote 41.4±31.2% (p<0.001). Internal medicine physicians had the best score after the first vote with 21.3±18.1 % and also performed best after the second vote 42.8±30.3% (p<0.001). People who attended the first iFAD had better scores than those who did not with 28.3±19% vs 14.6±16.6% respectively on the first vote (p<0.001), and 55.3±27.4% vs 31.3±26.1 % respectively on the second vote (p<0.001).
Conclusions
There is general lack of knowledge on hemodynamic and endorgan function 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 (by improving endorgan function) and mortality in critically ill patients, further educational efforts should be directed towards improving the knowledge on hemodynamic and organ function monitoring in combination with serum biomarkers to guide this fluid management. This can be done by organising state of the art lectures and evaluating acquired knowledge with a voting system.