Objective: To compare the safety and efficacy of isotonic versus hypotonic maintenance fluid in children. Design: Randomized controlled trial.Setting: Tertiary-level teaching hospital.Participants: 60 children (age 0.5 to 12 years) who were admitted and anticipated to receive intravenous fluid for the next 48 hours.Intervention: Hypotonic fluid (Standard maintenance volume as 0.18% NaCl in 5% dextrose) or Isotonic fluid (60% Standard maintenance volume as 0.9% NaCl solution in 5% dextrose).Outcome measures: Primary: Incidence of hyponatremia. Secondary: Serum sodium, serum osmolality, blood sugar, blood urea, serum creatinine, serum potassium, serum chloride, pH, urine output, change in weight, morbidity and death. Results: At 24 hours, hyponatremia was noted in 7 (24%) patients in the isotonic and 16 (55%) in hypotonic group (P=0.031). At 48 hours, hyponatremia was noted in 4 (14%) and 13 (45%) patients in isotonic and hypotonic group, respectively (P=0.02). There was significant change in sodium levels in both isotonic (P=0.036) and hypotonic (P<0.001) intervention groups. The peak fall in mean serum sodium level was noted at 24 hours (-6.5, 95%CI: -3.5, -9.6 mEq/L; P<0.001) in hypotonic group. In isotonic group, there was significant increase between 24 and 48 hours R R R R R E E E E E S S S S S E E E E E A A A A A R R R R R C C C C C H P H P H P H P H P A A A A A P P P P P E E E E E R R R R RR ecommendation for the use of a hypotonic saline solution (0.18% saline in 5% dextrose) in children is still a debated subject despite half a century of its practice [1]. Reports of symptomatic hyponatremia in hospitalized surgical and non-surgical pediatric patients -caused primarily by various non-osmotic release of vasopressin, but contributed by electrolyte-free water input in a proportion of cases -have fueled these debates [2][3][4][5]. Use of conventional volume maintenance isotonic saline has been shown to reduce the incidence of hyponatraemia [6]. Using indirect calorimetric measurements, energy expenditure in critically ill children may be as low as 50-60 kcal/kg/day [7]. Consequently, fluid requirement, which is directly proportional to the actual energy expenditure, is much less than previously assumed in critically ill children for a variety of reasons such as physical immobility, the use of muscle relaxants and sedatives, mechanical ventilation, and additional factors such as nonessential or facultative metabolism [8]. Therefore, we hypothesized that use of reduced volume isotonic maintenance fluid would decrease the incidence of hyponatremia in sick children, when compared to hypotonic fluid. We compared the efficacy and safety of isotonic fluid (0.9% NaCl in 5% dextrose) at the rate of 60% of daily fluid requirement versus hypotonic fluid (0.18% NaCl in 5% dextrose) at the rate of standard maintenance volume in sick children.Accompanying Editorials: Pages 963-66.
Background and Aims:Sudden cardiac deaths remain a major health problem worldwide. Most of these cases generally involve out of hospital cardiac arrest, making the role of bystander resuscitation very crucial. In the developing countries, illiteracy and scarcity of health professionals is a great barrier to cardiopulmonary resuscitation (CPR) training. Video-based CPR training can offer an easily accessible modality in these situations. Hence, this study was conducted with an aim to assess the efficacy of video-based training in comparison to the traditional instructor-based CPR training in layman.Methods:This prospective cross-over observational study included 109 undergraduate university students attending voluntary resuscitation training and were randomly divided into two groups of video-based demonstration (VBD) and instructor-based demonstration (IBD) of compression only life support (COLS). They were then assessed for psychomotor skill development (Laerdal Simpad Plus Q-CPR) and perception about the quality of training methodology as primary and secondary objectives, respectively.Results:Population characteristics were similar in both the groups. In the VBD, scene safety was performed by 95.2% and call for help by 97.6%, and by 76.1% each in the IBD group (P < 0.05). Response to compression time (RCT) was significantly shorter in VBD (35 ± 9 sec) as compared to IBD (54 ± 14 sec) (P < 0.001). However, the proportion of participants performing response check, correct site identification, and other parameters were comparable.Conclusion:Video-based COLS training significantly decreased the RCT by 35% compared to traditional instructor-based training. However, other features of high-quality CPR remain comparable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.