ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

Brossier, David; Tume, Lyvonne N.; Briant, Anaïs R; Chaparro, Corinne Jotterand; Moullet, Clémence; Rooze, Shancy; Verbruggen, Sascha; Marino, Luise V.; Alsohime, Fahad; Beldjilali, Sophie; Chiusolo, Fabrizio; Costa, Leonardo; Didier, Capucine; Ilia, Stavroula; Joram, Nyandat L.; Kneyber, Martin C. J.; Kühlwein, Eva; López, Jorge; López‐Herce, Jesús; Mayberry, Huw; Fortesa, Mehmeti; Mierzewska-Schmidt, Magdalena; Rodríguez, María Miñambres; Morice, Claire; Pappachan, John; Porcheret, Florence; Boto, Leonor; Schlapbach, Luregn J.; Tekgüç, Hakan; Tziouvas, Konstantinos; Parienti, Jean‐Jacques; Goyer, Isabelle; Valla, Frédéric V.

doi:10.1007/s00134-022-06882-z

Cited by 18 publications

(15 citation statements)

References 69 publications

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“…The most appropriate treatment method is still in debate. One of the main discussions is regarding the volume and the rate of administration of fluid used for IV rehydration, leading to great variability in the practice in paediatric emergency care [ 2 ]. We found that the highest prevalence of IV rehydration therapy was observed amongst paediatric patients who were hospitalised with dehydration [ 28 , 29 ] and rotavirus gastroenteritis [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fluid loss can be caused by surgery, accident, or common conditions such as fever, vomiting, and diarrhoea. Moreover, in some cases requiring hospitalisation such as acute renal failure, hyponatremia, hypercalcemia, acute pancreatitis, and sepsis, which are more common in adults, IV rehydration is the most important part of the treatment and can be lifesaving, even if there is no loss of fluid [ 2 , 3 ]. In addition, IV hydration is used to maintain hydration in paediatric and adult cancer patients or terminal care patients who do not have adequate oral intake [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, fluid prescription may be difficult, especially in patients with impaired homeostatic mechanisms, such as those with renal or heart failure, or in patients with ongoing excessive losses (e.g., as a result of diarrhoea) [ 6 ]. Moreover, incorrect management of fluid assessment and monitoring is associated with adverse outcomes such as hyponatremia (sodium concentration of less than 135 mmol/L (135 mEq/L)), fluid overload, and hyperchloremic acidosis (pH less than 7.35 develops with an increase in ionic chloride) due to inappropriate fluid composition and/or infusion rates/volumes [ 2 ]. For example, despite the obvious benefits of IV fluid therapy, excessive fluid administration may lead to various complications [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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The Prevalence and Indications of Intravenous Rehydration Therapy in Hospital Settings: A Systematic Review

et al. 2022

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(1) Objective: We performed a systematic review to explore the prevalence of intravenous (IV) rehydration therapy in hospital settings, and we assessed it by patient groups and populations. (2) Methods: A systematic review of major databases and grey literature was undertaken from inception to 28 March 2022. Studies reporting prevalence of IV rehydration therapy in a hospital setting were identified. The data were synthesised in a narrative approach. (3) Results: Overall, 29 papers met the inclusion criteria. The prevalence of IV rehydration therapy in paediatric patients ranged from 4.5% (hospitalised with diarrhoea and dehydration) to 100% (admitted to the emergency department with mild to moderate dehydration caused by viral gastroenteritis), and in adults this ranged from 1.5% (had single substance ingestion of modafinil) to 100% (hospitalised with hypercalcemia). The most common indication for IV rehydration therapy in paediatric patients was dehydration due to fluid loss from the gastrointestinal tract. Other causes included malnutrition, neuromuscular disease, bronchiolitis, and influenza. In adults, indications for IV rehydration therapy were much more diverse: fever, diarrhoea, drug intoxication, hypercalcemia, cancer, and postural tachycardia syndrome; (4) Conclusions: This systematic review showed that IV rehydration therapy in paediatric patients is often used to treat dehydration and diarrhoea, while in adults it has a broader spectrum of use. While IV rehydration therapy is important in correcting fluid problems and electrolyte status, the maintenance fluid prescribing practices vary considerably, and guidelines are scarce.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Prevalence and Indications of Intravenous Rehydration Therapy in Hospital Settings: A Systematic Review

et al. 2022

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“…In the absence of high level evidence, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC), has recently advocated the use of 65–80% of normal calculated fluid intake by the Holliday Segar formula as maintenance fluid intake in critically ill patients [75]. Fluid intake may be further restricted to 50–60% in cases with increased risk for fluid overload, such as those with cardiac or renal failure.…”

Section: Prevention and Treatment Of Fluid Overloadmentioning

confidence: 99%

Evaluating fluid overload in critically ill children

Bem,

Lemson

2024

Current Opinion in Pediatrics

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Purpose of review To review the evaluation and management of fluid overload in critically ill children. Recent findings Emerging evidence associates fluid overload, i.e. having a positive cumulative fluid balance, with adverse outcome in critically ill children. This is most likely the result of impaired organ function due to increased extravascular water content. The combination of a number of parameters, including physical, laboratory and radiographic markers, may aid the clinician in monitoring and quantifying fluid status, but all have important limitations, in particular to discriminate between intra- and extravascular water volume. Current guidelines advocate a restrictive fluid management, initiated early during the disease course, but are hampered by the lack of high quality evidence. Summary Recent advances in early evaluation of fluid status and (tailored) restrictive fluid management in critically ill children may decrease complications of fluid overload, potentially improving outcome. Further clinical trials are necessary to provide the clinician with solid recommendations.

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“…Balanced fluids, however, have other possible advantages that have been studied in a few pediatric clinical trials. Meta-analysis of these small trials suggest that balanced fluids are associated with less acidity, improved bicarbonate levels, and possibly a slightly reduced length of PICU stay (10, 11). Well designed and powered clinical trials on this topic are needed, and Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) trial (12) (www.clinicaltrials.gov/NCT04102371) is currently recruiting help to fill this evidence gap.…”

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confidence: 99%

Balancing Fluid Resuscitation in Pediatric Sepsis*

Branco

2023

Pediatric Critical Care Medicine

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F luid resuscitation remains a mainstay of sepsis treatment in children and adults. Historically, pediatric guidelines endorsed early, "aggressive" fluid resuscitation for children with sepsis. Compliance with these guidelines, that often-included large amount of fluid resuscitation, led to early recognition of sepsis and significant reductions in mortality in both developed and developing countries (1). More recently, however, there is growing recognition that IV fluids are not innocuous. Both quantitative and qualitative aspects of fluid resuscitation are being questioned, and concerns over issues such as fluid overload or fluid-induced hyperchloremic acidosis are being increasingly debated. These changes were reflected on the most recent pediatric Surviving Sepsis Campaign recommendations, that now support a more individualized approach to the use of fluid boluses and recommend the use of balanced/buffered crystalloids over 0.9% saline for the initial resuscitation of children with septic shock (2).The latter recommendation on balanced fluids was based on "very low quality of evidence" and the Campaign appropriately called for further high-quality pediatric data. In this issue of Pediatric Critical Care Medicine, Fernández-Sarmiento et al (3) make their important contribution to this topic. The authors assessed glycocalyx disruption associated with balanced and unbalanced fluid boluses in children with sepsis. The authors measured perfused boundary region (PBR) on sublingual video microscopy to assess endothelial glycocalyx thickness and blood levels of syndecan-1 as a biomarker for glycocalyx degradation. The study found that glycocalyx thickness decreased significantly 6 hours after fluid bolus in children receiving unbalanced fluids, while it remained mostly unchanged in children receiving a balanced fluid. The glycocalyx thickness reduction was associated with chloride and albumin levels, as well as markers of infection and inflammation. This is a very interesting topic because the glycocalyx regulates many of the key pathophysiological processes associated with sepsis and organ dysfunction. The glycocalyx is a ubiquitous protective layer lining the luminal surface of endothelial cells. It functions as more than just a physical barrier, it regulates essential aspects of microvascular homeostasis, helping to control microvascular permeability, mediate shear-induced vasorelaxation, and modulate cellwall interactions (4, 5). Glycocalyx loss exposes the endothelium and leads to increased fluid shift, edema, loss of vascular responsiveness, and leukocyte/ platelet endothelial interaction with increased inflammation and hypercoagulability. Controlling these processes would likely have a massive effect on the management and outcome of patients with sepsis.Although the glycocalyx was first visualized more than 50 years ago, its direct visualization in vivo remains a challenge. In the study by Fernández-Sarmiento et *See also p. 213.

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ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

Cited by 18 publications

References 69 publications

The Prevalence and Indications of Intravenous Rehydration Therapy in Hospital Settings: A Systematic Review

The Prevalence and Indications of Intravenous Rehydration Therapy in Hospital Settings: A Systematic Review

Evaluating fluid overload in critically ill children

Balancing Fluid Resuscitation in Pediatric Sepsis*

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