COVID-19 Fluid Stewardship Survey

Please fill in this survey and be eligible to win a FREE registration for next IFAD2020 in Brussels, Belgium (Nov 25-29) - either in person or via livestream.

Fluid administration and management are one of the fundamental practices of intensive care. The principles of good fluid practice are built upon the foundations of a firm understanding of the underlying pathophysiological process. COVID-19 is a novel illness and presents unique challenges not just to clinical practice but the entire healthcare system.
Personal Information

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* 1. What is your hospital?

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* 2. City?

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* 3. Country?

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* 4. Number of years working as a doctor (if <1 year: enter 0):

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* 5. What is your training status?

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* 6. Do you supervise trainees?

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* 7. What is your specialty?

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* 8. If surgery, please specify subspecialty:

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* 9. If Internal Medicine, please specify subspecialty:

Questions regarding treatment of hemodynamic unstable patients in emergency room, and operating theatre

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* 10. do you use starch solutions?

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* 11. Do you use balanced starch solutions (eg Volulyte)?

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* 12. When do you use starch solutions?

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* 13. Do you think it is safe to give a balanced infusion fluid with a potassium content of 5mEq/L to a patient with renal insufficiency and clearance of 25ml/min?

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* 14. Which is closest to the sodium content of saline or NaCl 0.9% (in mEq or mmol/L)

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* 15. How much free sodium is there in 1 L of saline?

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* 16. What is the maximum recommended daily sodium intake?

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* 17. Which is closest to the sodium content of a ready from the shelve balanced maintenance solution eg maintelyte or glucion 5% (in mEq/L )

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* 18. Which is closest to the glucose content of a balanced solution in g/L (egPlasmalyte)

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* 19. When would you use albumin 4%?

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* 20. When would you use albumin 20%?

Prescription practice

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* 21. Do you prescribe intravenous therapy?

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* 22. If you do not prescribe IV fluids routinely, why not?

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* 23. On what do you base your choice for a specific infusion? (multiple answers possible)

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* 24. If you are prescribing IV therapy, do you consider the patient’s oral intake? (on a scale from 1 = never to 5 = always)

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* 25. If you are prescribing IV therapy, do you take into account the volume of fluids that the patient receives through the administration of intravenous medication (like antibiotics, pain killers,…)?

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* 26. If you are prescribing IV therapy, do you consider the composition of the fluids present in the intravenous medication?

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* 27. If you prescribe an IV fluid infusion, how often do you re-evaluate the prescription?

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* 28. On a scale of 1-5 (1 = not at all, 5 = perfectly comfortable), how comfortable do you feel:

  1. Not at all 2. 3. 4. 5. Perfectly comfortable
When prescribing IV maintenance infusion?
Adding IV potassium to infusion therapy?
Prescribing a fluid bolus?
Information about own workplace

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* 29. In which department do you work?

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* 30. What do you think is the most prescribed infusion in your workplace?

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* 31. In my hospital there are already internal guidelines regarding the infusion policy

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* 32. In my ICU there are already internal guidelines regarding the infusion policy (only to be answered if they work in ICU)

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* 33. My nurses help determine which infusion is started for the patient.

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* 34. More specifically, the nurse determines the infusion:

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* 35. Frequency with which the nurse determines infusion:

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* 36. Are all the infusions you consider necessary available at your workplace?

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* 37. Is the patient's fluid balance systematically monitored at your workplace?

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* 38. Is the patient's weight systematically monitored at your workplace?

Case History (Presentation)
Female, 85 years, bedridden, weighs 50kg
History: MMSE 19/30, arterial hypertension, diabetes mellitus type 2, diverticulitis
Current problem: fever, increased confusion, blood pressure 99/55, pulse 119 / min
Laboratory: CRP 99 mg / dl, creatinine 2.1 mg / dl, urea 102 mg / dl, Na 145 mEq / L, K 3.5 mEq / L
Diagnosis: urosepsis. The patient appears dehydrated and has acute renal failure RIFLE I (injury), presumably prerenal.

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* 39. What is the most important clinical parameter for you to estimate volemic status?

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* 40. You decide to give a fluid bolus, how many mls would you use?

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* 41. Over what period of time do you give the fluid bolus?

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* 42. You decide to give a fluid challenge, how many mls would you use?

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* 43. What is the most important clinical parameter for you to estimate fluid responsiveness?

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* 44. Which infusion do you prefer here as a fluid bolus? Same comments as above

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* 45. What comes closest to the volume expansion effect of 1L gluc 5% after 1 hour?

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* 46. What is the problem with saline?

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* 47. What is the strong ion difference of saline?

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* 48. What comes closest to the volume expansion effect of 1L saline (NaCl 0.9%) after 1 hour?

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* 49. What is the strong ion difference of Plasmalyte?

Case Report (Evolution)
Female, 85 years, bedridden, weighs 50kg
History: MMSE 19/30, arterial hypertension, diabetes mellitus type 2, diverticulitis
Current problem: fever, increased confusion, blood pressure 99/55, pulse 119 / min
Laboratory: CRP 99 mg / dl, creatinine 2.1 mg / dl, urea 102 mg / dl, Na 145 mEq / L, K 3.5 mEq / L
Diagnosis: urosepsis. The patient appears dehydrated and has acute renal failure RIFLE I (injury), presumably prerenal.

Current situation: After resuscitation, paracetamol (1g IV in 100ml vial) and antibiotic therapy are started, the decision is made to admit the patient to the ward. However, there are strong doubts about the swallowing function of the patient, and you keep them nil by mouth until evaluation by speech therapy.

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* 50. Which infusion do you choose as maintenance fluid?

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* 51. What rate of maintenance infusion would you prescribe for this patient?

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* 52. What do you think is the daily Sodium requirement for this patient?

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* 53. What do you think is the daily Potassium requirement for this patient?

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* 54. What do you think is the daily glucose requirement for this patient?

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* 55. Do you require additional support for prescribing intravenous fluid therapy?

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* 56. Specify what additional information you would need (multiple options)

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* 57. In which ways would you like to receive more information about intravenous fluid administration? (multiple options)

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* 58. Do you have any other comments?

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* 59. If you want to stay informed or be actively involved in "fluid stewardship" or if you want to become an IFA Ambassador, please enter your name (given name and family name) and email address here.

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