Table 1 Comparison between doctors and nurses/nurse practitioners
Characteristic | All (n = 485) | No. (%) | P Value | |
|---|---|---|---|---|
Doctors (n = 388) | Nurses and nurse practitioners (n = 97) | |||
Country | ||||
 United Kingdom | 181 (37.3) | 101 (55.8) | 80 (44.2) | < 0.001 |
 Italy | 78 (16.1) | 68 (87.2) | 10 (12.8) | |
 Spain | 31 (6.4) | 31 (100.0) | 0 | |
 Greece | 24 (5.0) | 24 (100.0) | 0 | |
 France | 22 (4.5) | 22 (100.0) | 0 | |
 Portugal | 21 (4.3) | 19 (90.5) | 2 (9.5) | |
 Germany | 17 (3.5) | 17 (100.0) | 0 |  |
 Others | 111 (22.9) | 106 (95.5) | 5 (4.5) |  |
Occupation | ||||
 Advanced practice provider | 7 (1.4) |  |  |  |
 Dialysis nurse | 1 (0.2) |  |  |  |
 ICU nurse | 89 (18.4) | – | – |  |
 Intensivist | 365 (75.3) |  |  |  |
 Intensivist and nephrologist | 19 (3.9) |  |  |  |
 Nephrologist | 4 (0.8) |  |  |  |
Years of practice, median (IQR) | 16.3 (10–23.9) | 18.0 (11.0–25.0) | 10.0 (6.0–19.4) | < 0.001 |
Hospital Type | ||||
 University-based | 306 (63.1) | 247 (63.7) | 59 (60.8) | < 0.001 |
 Community-based | 110 (22.7) | 103 (26.6) | 7 (7.2) | |
 Government | 41 (8.5) | 19 (4.9) | 22 (22.7) | |
 Other | 28 (5.7) | 19 (4.9) | 9 (9.3) | |
Maximum dose of loop diuretic prescribed (furosemide equivalent)a, mgs/day (n = 394) | ||||
 < 100 | 41 (10.4) | 41 (10.6) | 0 (0.0) | 0.32 |
 100–250 | 132 (33.5) | 130 (33.6) | 2 (28.6) | |
 251–500 | 69 (17.5) | 68 (17.6) | 1 (14.3) | |
 501–750 | 25 (6.4) | 24 (6.2) | 1 (14.3) | |
 751–1000 | 66 (16.8) | 65 (16.8) | 1 (14.3) | |
 > 1000 | 30 (7.6) | 30 (7.8) | 0 (0.0) | |
 Other dose (e.g. 1–1.5 mg/kg) | 8 (2.0) | 8 (2.1) | 0 (0.0) |  |
 I do not prescribe diuretics. | 23 (5.8) | 21 (5.4) | 2 (28.6) |  |
Criteria used for initiation of UF a (n = 395) | ||||
 Persistent oliguria/anuria (urine output < 0.5 mL/kg/hour for ≥12 h) | 180 (45.6) | 176 (45.4) | 4 (57.1) | 0.23 |
 Severe hypoxemia (PaO2/FiO2 ratio < 150) | 38 (9.6) | 38 (9.8) | 0 (0.0) | |
 Pulmonary edema with or without hypoxemia | 66 (16.7) | 65 (16.8) | 1 (14.3) | |
 Cumulative fluid balance (> 1000 mL) | 19 (4.8) | 18 (4.6) | 1 (14.3) | |
 Fluid overload > 10% of body weight | 21 (5.3) | 21 (5.4) | 0 (0.0) | |
 Ongoing need for fluids in the presence of oliguria | 26 (6.6) | 26 (6.7) | 0 (0.0) | |
 I do not make the decision | 5 (1.3) | 4 (1.0) | 1 (14.3) |  |
 I use other criteria (e.g. acidosis, hyperkalemia, uremia) or combination of above criteria | 40 (10.1) | 40 (10.3) | 0 |  |
Criteria used for prescription of UFNET a (n = 395) | ||||
 24-h fluid balance | 63 (15.9) | 62 (16.0) | 1 (14.3) | 0.12 |
 Cumulative fluid balance | 88 (22.3) | 86 (22.2) | 2 (28.6) | |
 Weight gain | 31 (7.9) | 31 (8.0) | 0 (0.0) | |
 Radiographic features of fluid overload | 7 (1.8) | 7 (1.8) | 0 (0.0) | |
 Hemodynamic status (HR, BP, CVP, PPV, dose of vasopressors) | 177 (44.8) | 175 (45.1) | 2 (28.6) | |
 Volume of anticipated fluid use in the next 24 h | 10 (2.5) | 10 (2.6) | 0 (0.0) | |
 Arterial lactate | 1 (0.3) | 1 (0.3) | 0 (0.0) | |
 I do not prescribe UF. | 3 (0.8) | 2 (0.5) | 1 (14.3) |  |
 Others e.g. more than one criteria, lung ultrasound | 15 (3.8) | 14 (3.6) | 1 (14.3) |  |
IHD use, median (IQR) | ||||
 Percent use last month | 5.0 (0–25.0) | 5.0 (0.0–21.0) | 5.0 (0.5–32.5) | 0.18 |
 Typical prescription, mL per session | 2000 (1500–3000) | 2000 (1500–3000) | 2000 (1900–3000) | 0.91 |
Slow forms of IHD use, median (IQR) | ||||
 Percent use last month | 1.0 (0–20.0) | 1.0 (0–18.0) | 1.0 (0–20.0) | 0.87 |
 Typical prescription, mL per session | 2000 (1000–2000) | 2000 (1000–2900) | 3000 (0–4000) | 0.55 |
 Percent of assessment of prescription-to-delivered UFNET, median (IQR) | 79.5 (21.0–100.0) | 74.0 (28.0–100.0) | 81.0 (10.0–100.0) | 0.92 |
CRRT use, median (IQR) | ||||
 Percent use in the last month | 90.0 (30.0–100.0) | 90.0 (30.0–100.0) | 82.5 (41.5–100.0) | 0.60 |
 Initial UF rate for hemodynamically stable patient, mL per hour | 149.0 (100.0–200.0) | 151 (100–200) | 102 (100–200) | 0.058 |
 Maximal UF rate for hemodynamically stable patient, mL per hour | 300.0 (201.0–352.0) | 300 (201–358) | 300 (248–351) | 0.83 |
 UF rate for hemodynamically unstable patient, mL per hour | 98.0 (51.0–108.0) | 98 (51–106) | 81 (51–120) | 0.78 |
Method used to achieve UF using CRRT, No. (%) (n = 463) | ||||
 varying ultrafiltration rate only | 191 (41.3) | 133 (36.1) | 58 (61.1) | < 0.001 |
 varying replacement fluid rate only | 32 (6.9) | 30 (8.2) | 2 (2.1) | |
 varying both ultrafiltration and replacement fluid rate | 191 (41.3) | 166 (45.1) | 25 (26.3) | |
 I do not know. | 36 (7.8) | 29 (7.9) | 7 (7.4) |  |
 I do not prescribe UF. | 13 (2.8) | 10 (2.7) | 3 (3.2) |  |
How frequently do you check net fluid balance during CRRT? No. (%) (n = 463) | ||||
 1 h | 121 (26.1) | 57 (15.5) | 64 (67.4) | < 0.001 |
 2 h | 20 (4.3) | 16 (4.4) | 4 (4.2) | |
 4 h | 40 (8.6) | 35 (9.5) | 5 (5.3) | |
 6 h | 57 (12.3) | 51 (13.9) | 6 (6.3) | |
 8 h | 63 (13.6) | 57 (15.5) | 6 (6.3) | |
 12 h | 67 (14.5) | 65 (17.7) | 2 (2.1) | |
 24 h | 55 (11.9) | 53 (14.4) | 2 (2.1) | |
 I do not check net fluid balance. | 40 (8.6) | 34 (9.2) | 6 (6.3) |  |
Percentage of patients developing new hemodynamic instability during UF, median (IQR) | 20.0 (10.0–30.0) | 20.0 (10.0–30.0) | 14.0 (5.0–30.0) | 0.20 |
Interventions performed for hemodynamic instability | ||||
 Decrease the rate of fluid removal | 341 (70.1) | 269 (69.3) | 72 (74.2) | 0.35 |
 Completely stop fluid removal | 165 (33.8) | 119 (30.7) | 46 (47.4) | 0.002 |
 Make no changes to fluid removal rate | 19 (3.7) | 15 (3.9) | 4 (4.1) | 0.91 |
 Administer a fluid bolus | 175 (36.5) | 125 (32.2) | 50 (51.6) | < 0.001 |
 Start or increase the dose of a vasopressor | 245 (51.3) | 187 (48.2) | 58 (59.8) | 0.041 |
 Switch to alternative modality | 16 (3.3) | 14 (3.6) | 2 (2.1) | 0.45 |
 Administer albumin or mannitol bolus | 61 (13.4) | 50 (12.9) | 11 (11.3) | 0.68 |
Perceived barriers to UFNET | ||||
 Patient intolerance (e.g., hypotension) | 354 (72.6) | 271 (69.9) | 83 (85.6) | 0.002 |
 Under prescription | 71 (15.2) | 66 (17.0) | 5 (5.2) | 0.003 |
 Frequent interruptions (e.g., trip to CT scan, operating room, filter clotting, catheter malfunction) | 221 (45.3) | 158 (40.7) | 63 (65.0) | < 0.001 |
 Inability to titrate fluid removal | 21 (4.5) | 14 (3.6) | 7 (7.2) | 0.12 |
 Unavailability of adequately trained nursing staff | 37 (7.4) | 31 (8.0) | 6 (6.2) | 0.55 |
 Unavailability of dialysis machines | 29 (6.2) | 24 (6.2) | 5 (5.2) | 0.70 |
 Cost associated with treatment | 23 (4.7) | 19 (4.9) | 4 (4.1) | 0.75 |
I believe early fluid removal is beneficial | ||||
 Strongly agree | 159 (32.8) | 127 (32.7) | 32 (33.0) | 0.65 |
 Agree | 195 (40.2) | 152 (39.2) | 43 (44.3) | |
 Somewhat agree | 86 (17.7) | 71 (18.3) | 15 (15.5) | |
 Neither agree nor disagree | 34 (7.0) | 28 (7.2) | 6 (6.2) | |
 Somewhat disagree | 8 (1.7) | 8 (2.1) | 0 | |
 Disagree | 3 (0.6) | 2 (0.5) | 1 (1.0) | |
I believe a protocol-based fluid removal strategy would be beneficial | ||||
 Strongly agree | 123 (25.4) | 99 (25.5) | 24 (24.7) | 0.13 |
 Agree | 148 (30.5) | 122 (31.4) | 26 (26.8) | |
 Somewhat agree | 103 (21.2) | 81 (20.9) | 22 (22.7) | |
 Neither agree nor disagree | 52 (10.7) | 44 (11.3) | 8 (8.3) | |
 Somewhat disagree | 28 (5.8) | 20 (5.2) | 8 (8.3) | |
 Disagree | 22 (4.5) | 18 (4.6) | 4 (4.1) | |
 Strongly disagree | 9 (1.9) | 4 (1.0) | 5 (5.2) | |
I would enroll my patient in a clinical trial comparing protocol-based versus usual care (n = 484) | ||||
 Strongly agree | 127 (26.2) | 105 (27.1) | 22 (22.9) | 0.001 |
 Agree | 195 (40.3) | 160 (41.2) | 35 (36.5) | |
 Somewhat agree | 72 (14.9) | 63 (16.2) | 9 (9.4) | |
 Neither agree nor disagree | 61 (12.6) | 37 (9.5) | 24 (25) | |
 Somewhat disagree | 11 (2.3) | 9 (2.3) | 2 (2.1) | |
 Disagree | 15 (3.1) | 13 (3.4) | 2 (2.1) | |
 Strongly disagree | 3 (0.6) | 1 (0.3) | 2 (2.1 | |