Fluid resuscitation after cardiac surgery in the intensive care unit: A bi-national survey of clinician practice. (The FRACS-ICU clinician survey)

Ramanan, Mahesh; Roberts, Shaun; McCullough, James P.; Rapchuk, Ivan L.; Matebele, Mbakise; Tabah, Alexis; Krüger, Peter; Smith, Julian A.; Shekar, Kiran

doi:10.4103/aca.aca_190_20

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…In complex surgery, the child is often T A B L E 2 Demographics, patient characteristics and plasma tonicity in relation to sodium concentration during postoperative days 0 and 1. insufficient to maintain hemodynamics. 20,35,36 We do not consider the priming of the CPB is utilized in pediatric patients, as potential beneficial effects previously have been demonstrated with regard to improved hemodynamic stability and less positive postoperative fluid balance. 37,38 However, the use of colloids has become increasingly debated, not only in critically ill patients but also in adults after cardiac surgery since recent randomized controlled trials and systematic reviews cannot demonstrate any beneficial effect of colloids on morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…37,38 However, the use of colloids has become increasingly debated, not only in critically ill patients but also in adults after cardiac surgery since recent randomized controlled trials and systematic reviews cannot demonstrate any beneficial effect of colloids on morbidity and mortality. 36,[39][40][41][42] A one size fits all approach in terms of perioperative fluid recommendations in infants after CHD surgery is not recommendable. Not only due to the complexity and heterogenicity in infants undergoing CHD sur-…”

Section: Discussionmentioning

confidence: 99%

“…Unexpectedly, hyponatremia on POD1 was associated with the administration of human albumin, despite the fact that most human albumin solutions contain between 130 and 160 mmol/L of sodium. Colloids are often preferred as a second line of volume administration to reduce the total volume administered in cases of fluid overload, during ongoing fluid resuscitation, or if crystalloids are insufficient to maintain hemodynamics 20,35,36 . We do not consider the administration of human albumin to cause hyponatremia, but associations can go both ways.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative free water administration is associated with dysnatremia after congenital heart disease surgery in infants

Kronborg

Lindhardt

Vejlstrup

et al. 2023

Acta Anaesthesiol Scand

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Dysnatremia after congenital heart disease (CHD) surgery is common. European guidelines on intraoperative fluid therapy in children recommend isotonic solutions to avoid hyponatremia, but prolonged cardiopulmonary bypass and administration of high sodium-containing solutions (i.e., blood products and sodium bicarbonate) are associated with postoperative hypernatremia. The aim of the study was to describe fluid composition prior to and during the development of postoperative dysnatremia. A retrospective observational, single-center study including infants undergoing CHD surgery. Demographics and clinical characteristics were registered. Highest and lowest plasma sodium values were recorded and associations with perioperative fluid administration, blood products, crystalloids, and colloids were explored in relation to three perioperative periods. Postoperative dysnatremia occurred in nearly 50% of infants within 48 h after surgery. Hypernatremia was mainly associated with administration of blood products (median [IQR]: 50.5 [28.4-95.5] vs. 34.5 [18.5-61.1] mL/kg;p = 0.001), and lower free water load (1.6 [1.1-2.2] mL/kg/h; p = 0.01). Hyponatremia was associated with a higher free water load (2.3 [1.7-3.3] vs. 1.8 [1.4-2.5] mL/kg/h; p = 0.001) and positive fluid balance. On postoperative day 1, hyponatremia was associated with higher volumes of free water (2.0 [1.5-2.8] vs. 1.3 [1.1-1.8] mL/kg/h; p < 0.001) and human albumin, despite a larger diuresis and more negative daily fluid balance. Postoperative hyponatremia occurred in 30% of infants despite restrictive volumes of hypotonic maintenance fluid, whereas hypernatremia was mainly associated with blood product transfusion. Individualized fluid therapy, with continuous reassessment to reduce the occurrence of postoperative dysnatremia is mandatory in pediatric cardiac surgery. Prospective studies to evaluate fluid therapy in pediatric cardiac surgery patients are warranted.

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