Net ultrafiltration prescription survey in Europe
Abstract Background Fluid overload is common in patients in the intensive care unit (ICU) and ultrafiltration (UF) is frequently required. There is lack of guidance on optimal UF practice. We aimed to explore patterns of UF practice, barriers to achieving UF targets, and concerns related to UF pract...
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-020-02184-y |
| _version_ | 1819173833137979392 |
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| author | Nuttha Lumlertgul Raghavan Murugan Nina Seylanova Patricia McCready Marlies Ostermann |
| author_facet | Nuttha Lumlertgul Raghavan Murugan Nina Seylanova Patricia McCready Marlies Ostermann |
| author_sort | Nuttha Lumlertgul |
| collection | DOAJ |
| description | Abstract Background Fluid overload is common in patients in the intensive care unit (ICU) and ultrafiltration (UF) is frequently required. There is lack of guidance on optimal UF practice. We aimed to explore patterns of UF practice, barriers to achieving UF targets, and concerns related to UF practice among practitioners working in Europe. Methods This was a sub-study of an international open survey with focus on adult intensivists and nephrologists, advanced practice providers, and ICU and dialysis nurses working in Europe. Results Four hundred eighty-five practitioners (75% intensivists) from 31 countries completed the survey. The most common criteria for UF initiation was persistent oliguria/anuria (45.6%), followed by pulmonary edema (16.7%). Continuous renal replacement therapy was the preferred initial modality (90.0%). The median initial and maximal rate of net ultrafiltration (UFNET) prescription in hemodynamically stable patients were 149 mL/hr. (IQR 100–200) and 300 mL/hr. (IQR 201–352), respectively, compared to a median UFNET rate of 98 mL/hr. (IQR 51–108) in hemodynamically unstable patients and varied significantly between countries. Two-thirds of nurses and 15.5% of physicians reported assessing fluid balance hourly. When hemodynamic instability occurred, 70.1% of practitioners reported decreasing the rate of fluid removal, followed by starting or increasing the dose of a vasopressor (51.3%). Most respondents (90.7%) believed in early fluid removal and expressed willingness to participate in a study comparing protocol-based fluid removal versus usual care. Conclusions There was a significant variation in UF practice and perception among practitioners in Europe. Future research should focus on identifying the best strategies of prescribing and managing ultrafiltration in critically ill patients. |
| first_indexed | 2024-12-22T20:29:21Z |
| format | Article |
| id | doaj.art-e29f5907d2bd46cd8c7f86700c6279e3 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-22T20:29:21Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-e29f5907d2bd46cd8c7f86700c6279e32022-12-21T18:13:38ZengBMCBMC Nephrology1471-23692020-12-0121111210.1186/s12882-020-02184-yNet ultrafiltration prescription survey in EuropeNuttha Lumlertgul0Raghavan Murugan1Nina Seylanova2Patricia McCready3Marlies Ostermann4Department of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, NHS Foundation TrustThe Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of MedicineDepartment of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, NHS Foundation TrustDepartment of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, NHS Foundation TrustDepartment of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, NHS Foundation TrustAbstract Background Fluid overload is common in patients in the intensive care unit (ICU) and ultrafiltration (UF) is frequently required. There is lack of guidance on optimal UF practice. We aimed to explore patterns of UF practice, barriers to achieving UF targets, and concerns related to UF practice among practitioners working in Europe. Methods This was a sub-study of an international open survey with focus on adult intensivists and nephrologists, advanced practice providers, and ICU and dialysis nurses working in Europe. Results Four hundred eighty-five practitioners (75% intensivists) from 31 countries completed the survey. The most common criteria for UF initiation was persistent oliguria/anuria (45.6%), followed by pulmonary edema (16.7%). Continuous renal replacement therapy was the preferred initial modality (90.0%). The median initial and maximal rate of net ultrafiltration (UFNET) prescription in hemodynamically stable patients were 149 mL/hr. (IQR 100–200) and 300 mL/hr. (IQR 201–352), respectively, compared to a median UFNET rate of 98 mL/hr. (IQR 51–108) in hemodynamically unstable patients and varied significantly between countries. Two-thirds of nurses and 15.5% of physicians reported assessing fluid balance hourly. When hemodynamic instability occurred, 70.1% of practitioners reported decreasing the rate of fluid removal, followed by starting or increasing the dose of a vasopressor (51.3%). Most respondents (90.7%) believed in early fluid removal and expressed willingness to participate in a study comparing protocol-based fluid removal versus usual care. Conclusions There was a significant variation in UF practice and perception among practitioners in Europe. Future research should focus on identifying the best strategies of prescribing and managing ultrafiltration in critically ill patients.https://doi.org/10.1186/s12882-020-02184-yFluid overloadUltrafiltrationRenal replacement therapyFluid removal |
| spellingShingle | Nuttha Lumlertgul Raghavan Murugan Nina Seylanova Patricia McCready Marlies Ostermann Net ultrafiltration prescription survey in Europe BMC Nephrology Fluid overload Ultrafiltration Renal replacement therapy Fluid removal |
| title | Net ultrafiltration prescription survey in Europe |
| title_full | Net ultrafiltration prescription survey in Europe |
| title_fullStr | Net ultrafiltration prescription survey in Europe |
| title_full_unstemmed | Net ultrafiltration prescription survey in Europe |
| title_short | Net ultrafiltration prescription survey in Europe |
| title_sort | net ultrafiltration prescription survey in europe |
| topic | Fluid overload Ultrafiltration Renal replacement therapy Fluid removal |
| url | https://doi.org/10.1186/s12882-020-02184-y |
| work_keys_str_mv | AT nutthalumlertgul netultrafiltrationprescriptionsurveyineurope AT raghavanmurugan netultrafiltrationprescriptionsurveyineurope AT ninaseylanova netultrafiltrationprescriptionsurveyineurope AT patriciamccready netultrafiltrationprescriptionsurveyineurope AT marliesostermann netultrafiltrationprescriptionsurveyineurope |