Fluid bolus administration in children, who responds and how? A systematic review and meta‐analysis

Abstract

Background: Fluid boluses are frequently utilized in children. Despite their frequency of use, there is little objective data regarding the utility of fluid boluses, who they benefit the most, and what the effects are.Aims: This study aimed to conduct pooled analyses to identify those who may be more likely to respond to fluid boluses as well as characterize clinical changes associated with fluid boluses. Methods:A systematic review of the literature and meta-analysis was conducted to identify pediatric studies investigating the response to fluid boluses and clinical changes associated with fluid boluses.Results: A total of 15 studies with 637 patients were included in the final analyses with a mean age of 650 days ± 821.01 (95% CI 586 to 714) and a mean weight of 10.5 kg ± 7.19 (95% CI 9.94 to 11.1). The mean bolus volume was 12.14 ml/kg ± 4.09 (95% CI 11.8 to 12.5) given over a mean of 19.55 min ± 10.16 (95% CI 18.8 to 20.3).How to cite this article: Loomba RS, Villarreal EG, Farias JS, Flores S, Bronicki RA. Fluid bolus administration in children, who responds and how? A systematic review and metaanalysis.

Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

“…Though PLR demonstrated significant changes in preload (ΔHR, ΔSTR, ΔFTC, and ΔLVET), following PLR in our pediatric cohort, it failed to demonstrate fluid responsiveness as defined by ΔSV ≥10% from the baseline. 28 29 In short, our findings indicate that the utility of PLR in guiding fluid therapy in pediatric shock may be limited. It is likely that PLR at 45 degrees for 5 minutes may not generate an adequate auto-bolus in children.…”

Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting

“…In children in shock, the situation is more complex. Indeed, the choice of optimal therapy, between fluids or inotropes, must be based on the signs of preload: jugular turgor, rales at the lung bases, and hepatomegaly [90]. In this context, of increasing interest is the use of ultrasonography in the assessment of preload responsiveness through the use of dynamic rather than static assessment parameters, such as changes in vena-caval or cardiac dimensions, which appear to be more predictive of volume responsiveness [91].…”

Predicting Fluid Responsiveness in Critically Ill Children: So Many Tools and So Few Answers*

“…While many of these techniques accurately predict increases in stroke volume or cardiac output in adults following fluid bolus administration (5), evidence for their use in children has been more limited. Existing systematic reviews and meta-analyses of predictors of fluid responsiveness in children have demonstrated moderate-to-good prediction with respiratory variation in aortic blood flow peak velocity measured by ultrasound, but reviews consistently demonstrate poor predictive ability of other measures and substantial heterogeneity among included studies and patient populations (6)(7)(8).…”