Challenges, obstacles, and unknowns in implementing principles of modern intensive care medicine in low-resource settings: an insider's perspective

Kovacevic, Pedja; Meyer, F. Joachim; Gajic, Ognjen

doi:10.1007/s00134-023-07270-x

“…Finally, consideration should be given to cost and packaging. If these recommendations are to be applicable worldwide, including in low-and middle-income countries, the recommended fluids must be available at a reasonable price [12]. In addition, to overcoming the wide variability in patient characteristics encountered in paediatric practice, the recommended fluids should be available in a range of packaging formats, in order to reduce waste as well as the environmental footprint of plastic packaging [13].…”

Section: Discussionmentioning

confidence: 99%

How to follow the guidelines, when the appropriate fluid is missing?

Brossier,

Goyer,

Morice

et al. 2024

Preprint

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Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. Recently paediatric societies have produced evidence-based practice guidelines that recommend the use of balanced isotonic fluid when prescribing IV-MFT in both acute and critical paediatric care. Unfortunately, the applicability of these guidelines could be called into question when a ready-to-use glucose containing balanced isotonic fluid is not available. The main objective of this study was to describe the availability of glucose containing balanced isotonic fluids in European and Middle Eastern paediatric acute and critical care settings. This work is an ancillary study of the survey dedicated to IV-MFT practices in the paediatric acute and critical care settings in Europe and Middle East, a cross-sectional electronic 27-item survey, emailed in April–May 2021 to paediatric critical care physicians across 34 European and Middle East countries. The survey was developed by an expert multi-professional panel within the European Society of Peadiatric and Neonatal Intensive Care (ESPNIC). Balanced Isotonic Fluid with glucose 5% was available for only 32/153 (21%) responders. Balanced Isotonic Fluid with glucose 5% was consistently available in the United Kingdom (90%) but not available in France, Greece, The Netherlands and Turkey. Ready-to-use isotonic balanced IV solutions containing glucose in sufficient amount exist, but are inconsistently available through Europe. National and European Medication Safety Incentives should guarantee availability of the most appropriate and safest IV-MFT solution for all children.

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Data and ICU registries to improve care delivery in low-resource settings

Amado,

Quintairos,

Lanziotti

et al. 2024

Intensive Care Med

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How to follow the guidelines, when the appropriate fluid is missing?

Brossier,

Goyer,

Morice

et al. 2024

Eur J Pediatr

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Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. Recently paediatric societies have produced evidence-based practice guidelines that recommend the use of balanced isotonic fluid when prescribing IV-MFT in both acute and critical paediatric care. Unfortunately, the applicability of these guidelines could be called into question when a ready-to-use glucose-containing balanced isotonic fluid is not available. The main objective of this study was to describe the availability of glucose-containing balanced isotonic fluids in European and Middle Eastern paediatric acute and critical care settings. This work is an ancillary study of the survey dedicated to IV-MFT practices in the paediatric acute and critical care settings in Europe and Middle East, a cross-sectional electronic 27-item survey, emailed in April–May 2021 to paediatric critical care physicians across 34 European and Middle East countries. The survey was developed by an expert multi-professional panel within the European Society of Peadiatric and Neonatal Intensive Care (ESPNIC). Balanced isotonic fluid with glucose 5% was available for only 32/153 (21%) responders. Balanced isotonic fluid with glucose 5% was consistently available in the UK (90%) but not available in France, Greece, The Netherlands and Turkey. Conclusion: Ready-to-use isotonic balanced IV solutions containing glucose in sufficient amount exist but are inconsistently available throughout Europe. National and European Medication Safety Incentives should guarantee the availability of the most appropriate and safest IV-MFT solution for all children. What is Known:• Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care.• Balanced isotonic fluid is recommended when prescribing IV-MFT in both acute and critical paediatric care. What is New:• Balanced isotonic fluid with glucose 5% is available for less than 25% of the prescribers in Europe and the Middle East. Availability of balanced isotonic fluid with glucose 5% varies from one country to another but can also be inconsistent within the same country.• Clinicians who have access to a ready-to-use balanced isotonic fluid with glucose 5% are more likely to consider its use than clinicians who do not have access to such an IV solution.

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Challenges, obstacles, and unknowns in implementing principles of modern intensive care medicine in low-resource settings: an insider's perspective

Cited by 5 publications

References 16 publications

How to follow the guidelines, when the appropriate fluid is missing?

How to follow the guidelines, when the appropriate fluid is missing?

Data and ICU registries to improve care delivery in low-resource settings

How to follow the guidelines, when the appropriate fluid is missing?

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