Nordic survey on assessment and treatment of fluid overload in intensive care
IntroductionFluid overload in patients in the intensive care unit (ICU) is associated with higher mortality. There are few randomized controlled trials to guide physicians in treating patients with fluid overload in the ICU, and no guidelines exist. We aimed to elucidate how ICU physicians from Nord...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.1067162/full |
| _version_ | 1811305073239654400 |
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| author | Emilie Zeuthen Sine Wichmann Martin Schønemann-Lund Mikko J. Järvisalo Mikko J. Järvisalo Rebecka Rubenson-Wahlin Rebecka Rubenson-Wahlin Martin I. Sigurðsson Martin I. Sigurðsson Erling Holen Morten H. Bestle Morten H. Bestle |
| author_facet | Emilie Zeuthen Sine Wichmann Martin Schønemann-Lund Mikko J. Järvisalo Mikko J. Järvisalo Rebecka Rubenson-Wahlin Rebecka Rubenson-Wahlin Martin I. Sigurðsson Martin I. Sigurðsson Erling Holen Morten H. Bestle Morten H. Bestle |
| author_sort | Emilie Zeuthen |
| collection | DOAJ |
| description | IntroductionFluid overload in patients in the intensive care unit (ICU) is associated with higher mortality. There are few randomized controlled trials to guide physicians in treating patients with fluid overload in the ICU, and no guidelines exist. We aimed to elucidate how ICU physicians from Nordic countries define, assess, and treat fluid overload in the ICU.Materials and methodsWe developed an online questionnaire with 18 questions. The questions were pre-tested and revised by specialists in intensive care medicine. Through a network of national coordinators. The survey was distributed to a wide range of Nordic ICU physicians. The distribution started on January 5th, 2022 and ended on May 6th, 2022.ResultsWe received a total of 1,066 responses from Denmark, Norway, Finland, Sweden, and Iceland. When assessing fluid status, respondents applied clinical parameters such as clinical examination findings, cumulative fluid balance, body weight, and urine output more frequently than cardiac/lung ultrasound, radiological appearances, and cardiac output monitoring. A large proportion of the respondents agreed that a 5% increase or more in body weight from baseline supported the diagnosis of fluid overload. The preferred de-resuscitation strategy was diuretics (91%), followed by minimization of maintenance (76%) and resuscitation fluids (71%). The majority declared that despite mild hypotension, mild hypernatremia, and ongoing vasopressor, they would not withhold treatment of fluid overload and would continue diuretics. The respondents were divided when it came to treating fluid overload with loop diuretics in patients receiving noradrenaline. Around 1% would not administer noradrenaline and diuretics simultaneously and 35% did not have a fixed upper limit for the dosage. The remaining respondents 63% reported different upper limits of noradrenaline infusion (0.05–0.50 mcg/kg/min) when administering loop diuretics.ConclusionSelf-reported practices among Nordic ICU physicians when assessing, diagnosing, and treating fluid overload reveals variability in the practice. A 5% increase in body weight was considered a minimum to support the diagnosis of fluid overload. Clinical examination findings were preferred for assessing, diagnosing and treating fluid overload, and diuretics were the preferred treatment modality. |
| first_indexed | 2024-04-13T08:18:46Z |
| format | Article |
| id | doaj.art-28573ca3b461429bb9bbe58eb2992531 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-13T08:18:46Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-28573ca3b461429bb9bbe58eb29925312022-12-22T02:54:42ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-11-01910.3389/fmed.2022.10671621067162Nordic survey on assessment and treatment of fluid overload in intensive careEmilie Zeuthen0Sine Wichmann1Martin Schønemann-Lund2Mikko J. Järvisalo3Mikko J. Järvisalo4Rebecka Rubenson-Wahlin5Rebecka Rubenson-Wahlin6Martin I. Sigurðsson7Martin I. Sigurðsson8Erling Holen9Morten H. Bestle10Morten H. Bestle11Department of Anesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, DenmarkDepartment of Anesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, DenmarkDepartment of Anesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, DenmarkPerioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, FinlandKidney Center, Turku University Hospital, University of Turku, Turku, FinlandDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, SwedenDepartment of Anesthesia and Intensive Care, Södersjukhuset, Stockholm, SwedenDepartment of Anesthesia and Critical Care, Landspitali – The National University Hospital of Iceland, Reykjavík, IcelandFaculty of Medicine, University of Iceland, Reykjavík, IcelandDepartment of Anesthesia and Intensive Care, Helse Stavanger University Hospital, Stavanger, NorwayDepartment of Anesthesia and Intensive Care, Copenhagen University Hospital, North Zealand, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkIntroductionFluid overload in patients in the intensive care unit (ICU) is associated with higher mortality. There are few randomized controlled trials to guide physicians in treating patients with fluid overload in the ICU, and no guidelines exist. We aimed to elucidate how ICU physicians from Nordic countries define, assess, and treat fluid overload in the ICU.Materials and methodsWe developed an online questionnaire with 18 questions. The questions were pre-tested and revised by specialists in intensive care medicine. Through a network of national coordinators. The survey was distributed to a wide range of Nordic ICU physicians. The distribution started on January 5th, 2022 and ended on May 6th, 2022.ResultsWe received a total of 1,066 responses from Denmark, Norway, Finland, Sweden, and Iceland. When assessing fluid status, respondents applied clinical parameters such as clinical examination findings, cumulative fluid balance, body weight, and urine output more frequently than cardiac/lung ultrasound, radiological appearances, and cardiac output monitoring. A large proportion of the respondents agreed that a 5% increase or more in body weight from baseline supported the diagnosis of fluid overload. The preferred de-resuscitation strategy was diuretics (91%), followed by minimization of maintenance (76%) and resuscitation fluids (71%). The majority declared that despite mild hypotension, mild hypernatremia, and ongoing vasopressor, they would not withhold treatment of fluid overload and would continue diuretics. The respondents were divided when it came to treating fluid overload with loop diuretics in patients receiving noradrenaline. Around 1% would not administer noradrenaline and diuretics simultaneously and 35% did not have a fixed upper limit for the dosage. The remaining respondents 63% reported different upper limits of noradrenaline infusion (0.05–0.50 mcg/kg/min) when administering loop diuretics.ConclusionSelf-reported practices among Nordic ICU physicians when assessing, diagnosing, and treating fluid overload reveals variability in the practice. A 5% increase in body weight was considered a minimum to support the diagnosis of fluid overload. Clinical examination findings were preferred for assessing, diagnosing and treating fluid overload, and diuretics were the preferred treatment modality.https://www.frontiersin.org/articles/10.3389/fmed.2022.1067162/fullfluid accumulationfluid removalsurveydiureticsfluid overloadICU |
| spellingShingle | Emilie Zeuthen Sine Wichmann Martin Schønemann-Lund Mikko J. Järvisalo Mikko J. Järvisalo Rebecka Rubenson-Wahlin Rebecka Rubenson-Wahlin Martin I. Sigurðsson Martin I. Sigurðsson Erling Holen Morten H. Bestle Morten H. Bestle Nordic survey on assessment and treatment of fluid overload in intensive care Frontiers in Medicine fluid accumulation fluid removal survey diuretics fluid overload ICU |
| title | Nordic survey on assessment and treatment of fluid overload in intensive care |
| title_full | Nordic survey on assessment and treatment of fluid overload in intensive care |
| title_fullStr | Nordic survey on assessment and treatment of fluid overload in intensive care |
| title_full_unstemmed | Nordic survey on assessment and treatment of fluid overload in intensive care |
| title_short | Nordic survey on assessment and treatment of fluid overload in intensive care |
| title_sort | nordic survey on assessment and treatment of fluid overload in intensive care |
| topic | fluid accumulation fluid removal survey diuretics fluid overload ICU |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.1067162/full |
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