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

Abstract

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.