Net ultrafiltration prescription survey in Europe
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RESEARCH ARTICLE
Open Access
Net ultrafiltration prescription survey in Europe Nuttha Lumlertgul1,2,3,4, Raghavan Murugan5,6, Nina Seylanova1,7, Patricia McCready1 and Marlies Ostermann1*
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. Keywords: Fluid overload, Ultrafiltration, Renal replacement therapy, Fluid removal
Background Fluid overload is common in intensive care units (ICU) and is strongly associated with increased mortality, impaired renal recovery, and distant organ dysfunction among critically ill patients [1, 2]. Achieving euvolemia after the initial fluid resuscitation phase consists of minimizing fluid input and removing excessive fluid [3]. There are two strategies for removing fluid, diuretic pharmacotherapy and mechanical fluid removal using slow continuous ultrafiltration (SCUF) or renal replacement therapy (RRT) [4]. * Correspondence: [email protected] 1 Department of Critical Care, King’s College London, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, London SE1 7EH, UK Full list of author information is available at the end of the article
Mechanical fluid removal is usually considered in patients deemed inadequately responsive to diuretics, so called ‘diuretic-resistant’ [4, 5]. However, there is no clear defin
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