Meeting report of the First International Fluid Academy Day Part 1: Results of the survey on the knowledge of fluid management
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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. Many questions with regard to the type of fluids, the timing and the dosing remain unanswered. Recent data suggest that fluids should be dealt with as any other type of medication.
Objective
To assess the awareness and current knowledge on fluid management 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 19'h 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 votings were compared. This paper reports on the results of the first part of the questionnaire including 7 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.
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 respondents resided in the following countries: Belgium 43.4%, The Netherlands 20.l %, United Kingdom 9.4%, Germany 5%, France 3.1 %, and 18.9% came from other countries. The distribution of the primary speciality was: anaesthesiology 36.5%, intensive care medicine 23.3%, emergency medicine 18.2%, internal medicine 18.2%, surgery 1.3% while 2.5% were not a doctor. With regard to the years of experience in the ICU, 6.3% answered to be in training, 11.9% had 1 to 5 years of experience, 18.9% between 5 and 15 and 44% stated to have more than 15 years experience, finally 18.9% answered not working in an ICU. The average overall score on the 7 knowledge questions on fluids and fluid management after the first vote was 26.6±17.4% vs 48.7±21.8% after the second vote (p<0.0001). The best score after the first vote was for Belgium with 29.5±18.7% and Germany having the worst (19.3± 12.8% ). After the second vote this was respectively the Netherlands ( 51.3±21.7%) and again Germany (40.5±12.l %). Residents in training had the best scores, 36.6±21.4% after the first and 56.8±27% after the second vote (p<0.0001). Emergency physicians had the best score after the first vote with 31±14.4% while intensivists performed best after the second vote 54.7±20.8%.
Conclusions
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 acquired knowledge with a voting system.