Data_Sheet_1_Nordic survey on assessment and treatment of fluid overload in intensive care.docx

IntroductionFluid overload in patients in the intensive care unit (ICU) is associated with higher mortality. There are few randomized controlled trials to guide physicians in treating patients with fluid overload in the ICU, and no guidelines exist. We aimed to elucidate how ICU physicians from Nordic countries define, assess, and treat fluid overload in the ICU.Materials and methodsWe developed an online questionnaire with 18 questions. The questions were pre-tested and revised by specialists in intensive care medicine. Through a network of national coordinators. The survey was distributed to a wide range of Nordic ICU physicians. The distribution started on January 5th, 2022 and ended on May 6th, 2022.ResultsWe received a total of 1,066 responses from Denmark, Norway, Finland, Sweden, and Iceland. When assessing fluid status, respondents applied clinical parameters such as clinical examination findings, cumulative fluid balance, body weight, and urine output more frequently than cardiac/lung ultrasound, radiological appearances, and cardiac output monitoring. A large proportion of the respondents agreed that a 5% increase or more in body weight from baseline supported the diagnosis of fluid overload. The preferred de-resuscitation strategy was diuretics (91%), followed by minimization of maintenance (76%) and resuscitation fluids (71%). The majority declared that despite mild hypotension, mild hypernatremia, and ongoing vasopressor, they would not withhold treatment of fluid overload and would continue diuretics. The respondents were divided when it came to treating fluid overload with loop diuretics in patients receiving noradrenaline. Around 1% would not administer noradrenaline and diuretics simultaneously and 35% did not have a fixed upper limit for the dosage. The remaining respondents 63% reported different upper limits of noradrenaline infusion (0.05–0.50 mcg/kg/min) when administering loop diuretics.ConclusionSelf-reported practices among Nordic ICU physicians when assessing, diagnosing, and treating fluid overload reveals variability in the practice. A 5% increase in body weight was considered a minimum to support the diagnosis of fluid overload. Clinical examination findings were preferred for assessing, diagnosing and treating fluid overload, and diuretics were the preferred treatment modality.

重症监护病房（ICU）患者的水分超负荷与死亡率增加密切相关。目前缺乏随机对照试验来指导医生治疗ICU患者的水分超负荷，且尚无相关指南。本研究旨在阐明北欧国家ICU医生如何定义、评估和治疗ICU患者的水分超负荷。

研究材料与方法：我们开发了一份包含18个问题的在线问卷。这些问题由重症监护医学专家进行预测试和修订。通过国家协调员网络，问卷被广泛分发给北欧各国的ICU医生。问卷分发始于2022年1月5日，结束于2022年5月6日。

研究结果：我们共收到来自丹麦、挪威、芬兰、瑞典和冰岛的1066份回复。在评估水分状态时，受访者更频繁地应用临床参数，如临床检查发现、累积液体平衡、体重和尿量，而非心脏/肺超声、影像学表现和心脏输出量监测。大部分受访者认为，从基线体重增加5%或更多可以支持水分超负荷的诊断。最优先的脱水利尿策略是利尿剂（91%），其次是维持量最小化（76%）和复苏液体（71%）。大多数受访者表示，即使在轻度低血压、轻度高钠血症和持续使用血管加压药的情况下，他们也不会停止治疗水分超负荷，并且会继续使用利尿剂。在是否对使用去甲肾上腺素的病人同时使用利尿剂的问题上，受访者意见不一。大约1%的人不会同时使用去甲肾上腺素和利尿剂，35%的人没有固定的剂量上限。剩余的63%受访者报告了不同的去甲肾上腺素输注上限（0.05–0.50 mcg/kg/min），在给予袢利尿剂时。

结论：北欧ICU医生在评估、诊断和治疗水分超负荷的自我报告实践表明，临床实践存在差异。体重增加5%被视为支持水分超负荷诊断的最低标准。临床检查发现是评估、诊断和治疗水分超负荷的首选方法，利尿剂是首选的治疗方式。