Knowledge about fluid responsiveness among Emergency versus Critical Care Physicians Mohammed H Elwan [1, 2], Ashraf Roshdy [3, 4], Joseph Reynolds [2], Timothy J Coats [2] [1]
Department of Emergency Medicine, Alexandria University, Alexandria, Egypt, [2] Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. [3] Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt, [4] Queen Elizabeth, Lewisham and Greenwich NHS Trust, UK
(i)
Introduction
(ii) Methods
Correct management of fluid therapy is vital in the shocked patient – both too little and too much are harmful and yet there is much uncertainty over both the amount to give and when to stop (1). Fluid responsiveness, which is the haemodynamic response to a preload challenge, has been suggested as a dynamic method to titrate resuscitation. Our aim was to evaluate the knowledge, attitude and current practice of fluid responsiveness amongst Emergency Physicians (EPs) and Critical Care Physicians (CCPs) in Egypt.
(iii)
A questionnaire was sent via SurveryMonkey to Emergency and Critical Care Residents and Specialists in Alexandria University Hospital, which is a large urban teaching hospital in Egypt. The Mann-Whitney test was used to test statistical significance between groups.
Results
The 32 EPs and 40 CCPs that responded both had a median of 4 years of clinical experience Figure 1: perceived knowledge about fluid response
Figure 2: dynamic test used to test fluid response
Figure 3: perceived ideal method for guiding fluid therapy
Figure 4: method actually used in practice for guiding fluid therapy
(v) Discussion EPs relied more on clinical parameters, whereas CCPs showed more preference to alternative methods. This can be attributed to the more fast-paced pragmatic nature in emergency department. CVP is still regarded as important by CCPs despite criticism in recent literature. This may be a form of availability bias – where what is available is regarded as important. Ultrasound/ Echocardiography seem to have gained much popularity. However, it may be that the skill required is not well established to translate into practice.
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Twitter: @drmhuss
References 1. Elwan MH, Roshdy A, Elsharkawy EM, et al. The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017;25(1):25
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