Meeting report of the First International Fluid Academy Day Part 3: Results of the general and knowledge survey on fluid management and hemodynamic monitoring
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Manu L. N. G. Malbrain, Niels Van Regenmortel, Dirk HimpeAbstract/Text
Background
Fluid management in the critically ill has been neglected for way too long and although the use of 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. Objective To assess the awareness and current knowledge on fluid management and hemodynamic monitoring among critical care physicians.
Methods
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 global results of both parts of the questionnaire including 7 knowledge questions on fluid management and 7 knowledge questions on hemodynamic monitoring and fluid responsiveness. The respondents also provided information on their country of residence, basic speciality and years of experience and they gave feedback on general questions. 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.
Results
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 14 knowledge questions on fluid management and hemodynamic monitoring after the first vote was 26±15.l % vs 45.9±20.7% after the second vote (p<0.0001). The best score after the first vote was for The Netherlands with 27.5±16.l % and Germany having the worst (19.4±14.7%).After the second vote this was again the Netherlands (49.1±21.9%) and again Germany (38±18.80/o)(ANOVA p=NS). Residents in training had the best score with 33.8±20.3% after the first vote and they also had the best score after the second vote with 51.1±23% in ex-aequo with those with 1 to 5 years of experience 49.2±26.6% (ANOVA p=NS). Intensivists had the best score after the first vote with 31.2±14.9% and also performed best after the second vote 55.2±18.6% (AN OVA p=0.015).
Conclusions
With a global score of 26±15.l % after the first vote vs 45.9±20.7% after the second vote this survey confirms that there is a general lack of knowledge on fluid management, 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.