IFAD Survey on Urine monitoring

General information

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* 1. What is your education?

Attending Physician

Resident / Fellow Physician

Advanced Practice Provider (PA, CRNP, CRNA)

Nurse

Nurse in training (student RN)

Doctor in training (student MD)

Industry affiliated

Other (please specify)

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* 2. Are you an intensivist? Are you board-certified / eligible in Critical Care (Medical or Surgical)?

Yes

Working on it (Currently in training for Critical Care)

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* 3. What is your basic speciality (when relevant)?

Anaesthesia

Internal Medicine

Emergency Medicine

Surgery

Pediatrics

not a doctor

Other (please specify)

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* 4. How many years of experience do you have?

0 (still in training)

1-5

6-10

11-20

>20

retired

Urine output monitoring

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* 5. How often do you need urine output information?

Continuous

Hourly

Every 4 Hours

Once per nursing shift

Once per day (daily fluid balance)

Other (please specify)

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* 6. Do you trust the urine output data that you are receiving?

Yes

Maybe

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* 7. How frequently do you (or the nurse) have to manipulate the catheter to drain the urine fluid so it can be measured?

Never

10-20% of the time

20-30% of the time

50% or greater

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* 8. In your opinion, what do you consider to be a good standard of urine output monitoring in patients on hospital wards after a period in theatre recovery, in the first 24 hours following elective surgery (eg colorectal resection)?

Urine volumes recorded every hour

Urine volumes recorded every 2 hours

Urine volumes recorded every 3-4 hours

Urine volume recorded every 5-6 hours

Urine volume recorded every 7-8 hours

Urine volumes recorded every 9-12 hours

Urine volumes recorded every 13-24 hours

Other (please specify)

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* 9. In your opinion, what do you consider to be a good standard of urine output monitoring in patients on hospital wards, in the following 24-72 hours following elective surgery (eg colorectal resection)?

Urine volumes recorded every hour

Urine volumes recorded every 2 hours

Urine volumes recorded every 3-4 hours

Urine volume recorded every 5-6 hours

Urine volume recorded every 7-8 hours

Urine volumes recorded every 9-12 hours

Urine volumes recorded every 13-24 hours

Other (please specify)

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* 10. Missed care has been defined as care that is delayed, partially completed or not completed at all. In your opinion, in the first 24 hours following hip fracture surgery, what would you consider to be missed care with regard to urine output monitoring in patients on hospital wards?

Urine volumes recorded less than once every 2 hours

Urine volumes recorded less than once every 4 hours

Urine volumes recorded less than once every 6 hours

Urine volumes recorded less than once every 8 hours

Urine volumes recorded less than once every 12 hours

Urine volumes recorded less than once every 24 hours

Other (please specify)

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* 11. In the following 24-72 hours after hip fracture surgery, what would you consider to be missed care with regard to urine output monitoring on hospital wards?

Urine volumes recorded less than once every 2 hours

Urine volumes recorded less than once every 4 hours

Urine volumes recorded less than once every 6 hours

Urine volumes recorded less than once every 8 hours

Urine volumes recorded less than once every 12 hours

Urine volumes recorded less than once every 24 hours

Other (please specify)

Intra-abdominal pressure monitoring

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* 12. Do you currently measure Intra-Abdominal Pressure (IAP) in your practice?

Yes, frequently

Yes, occasionally

Yes, rarely

No never

I don’t have a need for measuring IAP

Other (please specify)

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* 13. How often do you need/measure abdominal pressure information?

Continuous

Hourly

Every 4 Hours

Once per nursing shift

Once per day

Other (please specify)

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* 14. How do you currently measure Intra-Abdominal Pressure (IAP) in your practice?

Urinary bladder, intermittent measurement

Urinary bladder, continuous measurement

Gastric, intermittent measurement

Gastric, continuous measurement

Other (please specify)

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* 15. Is continuous IAP monitoring useful in critically ill patients?

Yes, very helpful. I have been waiting for continuous IAP for years.

Yes, helpful

Not helpful

Only in specific patients

Other (please specify)

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* 16. Would continuous abdominal pressure monitoring help manage critically ill patients?

Yes, very helpful

Yes, helpful

Not helpful

Only in specific patients

Other (please specify)

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* 17. How would you use continuous abdominal perfusion pressure (APP) if it was available to you?

I would target APP>50 mmHg

I would target APP>60 mmHg

I would still target MAP only. Who cares about APP?

Other (please specify)

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* 18. How would you optimize APP?

Target a specific APP

Vasodilators

Inotropes

Vasopressors

Fluids

I need SVV/PPV and CO to make an informed decision

I don't care

Other (please specify)

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* 19. In what patient populations are you tracking IAP on most commonly? (check all that apply)

All critically ill

Mechanically ventilated patients

Trauma patients

Cardiac surgery patients

Septic patients

Patients with Burns

Severe acute pancreatitis

Liver cirrhosis

Major abdominal surgery (elective)

Major abdominal surgery (emergency)

Patients with new organ failure (eg AKI)

Patients with cardiorenal dilemma

Major vascular surgery (eg AAA)

Other (please specify)

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* 20. Do you think that abdominal pressure (IAP) can help with fluid management?

Yes

Maybe

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* 21. What parameters do you use to assess fluid status (check all that apply):

IAP

urine output

CVP

MAP

Volumetric preload (GEDVI)

Ultrasound

Functional hemodynamics (PPV, SVV)

Passive leg raising test

PulseOx (PVI)

Other (please specify)

AKI Diagnosis

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* 22. Imagine you knew what patients have a high risk of going into CSA-AKI 32 hours in advance. How would you change your practice? What would you do:

Nothing, continue my usual care

Institute a complete kidney care bundle (regular monitoring of kidney function, hemodynamic optimization, consideration of advanced hemodynamic monitoring, avoidance of hyperglycemia, nephrotoxic drugs, and radiocontrast agents, avoidance of ACE/ARBS for 48hrs post-op, avoidance of saline solutions or HES for 72 hours)

Institute the following parts of the KDIGO bundle:

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* 23. Are you more concerned about nursing telling you your patient is in stage 1 AKI by UO criteria or that your patient is oliguric over six hours?

Stage 1 AKI

Oliguric for 6 hours

Other (please specify):

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* 24. If you were to implement AKI management algorithms at your hospital, what literature/evidence would you turn to?

KDIGO/AKIN

RCT

Observational studies

Recommendations by societies

Other (please specify):

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* 25. If you identify a technology that you think will help manage AKI or IAH what information is required to purchase this technology? (rank in order of importance)

Future monitoring tools

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* 26. What are most important features you would want in a urinary catheter device? (select all that apply)

Temperature

Portable

Wireless connectivity

Plug and play using existing Foley

Urine Electrolytes

Urine density, osmolarity

Abdominal pressure

Urine pH

Urine pO2, or bladder saturation

Pulse Ox (urethral)

Continuous GFR

Possibility for dynamic tests like furosemide stress test

Ability to automatically integrate with EMR

Other (please specify)

Note: “The Pulse ox is directly pulling the O2 content from the blood supply of the urethra which isn’t effected by the pigment (melanin) in the skin and has no influence of hemodynamic status, pressor agents, temperature, surface of skin evaluating (burns) etc.”

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* 27. Would a bladder drainage catheter with real-time Intra-Abdominal Pressure (IAP) measurements, core body temperature, and PulseOx readings all from one device be of interest to you?

Yes

Maybe

Need more information

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* 28. What challenges have you experienced with your current Pulse Ox solution? (select all that apply:

Inaccuracy due to dark skin pigmentation

Inaccuracy due to hypothermia

Inaccuracy due to poor innate peripheral circulation

Inaccuracy due to vasopressor use resulting in poor tissue perfusion

Inaccuracy due to sepsis resulting in poor tissue perfusion

Inaccuracy due to injury/surgery on extremities

Inability for probe to stay adherent to patient

Probe interferes with sterile field

Connectivity issues with equipment to monitor

Other (please specify)

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* 29. Which HCP group would be best suited to make purchasing decisions?

Trauma specialist

ICU physician

Anesthesiologist

General Surgeons

OR / ICU nurses

Other (please specify)

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* 30. How quickly would you anticipate purchasing this bladder drainage catheter device?

ASAP

2 - 3 months

4 - 5 months

> 6 months

Other (please specify)

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* 31. Would a product evaluation be required before purchasing?

Yes

Other (please specify)

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* 32. How much would you anticipate the hospital paying for such a device?

<$400

$400

$500

$600

$600+

Other (please specify)

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* 33. Do you have any additional feedback?

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* 34. If you would like more information (on continuous urine output, abdominal pressure or urethral pulseOx), please provide contact info below (optional)

First (given) Name

Family Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address