Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

McCammond, Amy N.; Axelrod, David M.; Bailly, David K.; Ramsey, E. Zachary; Costello, John M.

doi:10.1097/pcc.0000000000000633

Cited by 33 publications

(10 citation statements)

References 158 publications

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“…To date, there are no recommendations regarding fluid management in pediatric patients undergoing cardiac surgery 15,16,19,20 . The need for evidence‐based recommendations has been highlighted in a recent consensus statement and in a recent survey showing large international variations in postoperative fluid therapy, including maintenance fluid tonicity and postoperative fluid restriction, 20,34 which is further emphasized by observations in the present study.…”

Section: Discussionmentioning

confidence: 59%

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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Section: Discussionmentioning

confidence: 59%

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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show abstract

“…Alterations of intravascular and total body fluid in pediatric patients following cardiac surgery result from intrinsic myocardial dysfunction, neuroendocrine response, renal dysfunction, inflammatory cascade induced by cardiopulmonary bypass, increased capillary permeability, decreased plasma oncotic pressure, increased tissue osmotic pressure, and endothelial dysfunction. [21][22][23][24] Capillary leak and low cardiac output syndrome are more pronounced during the first 6 to 18 hours following cardiac surgery. 24,25 The resulting fluid overload may contribute to acute kidney injury, prolonged mechanical ventilation, need for vasoactive support, prolonged intensive care unit and hospital LOSs, and mortality.…”

Section: Diuretics and Fluid Restrictionmentioning

confidence: 99%

Quality Report: Postoperative Guideline Implementation Reduces Length of Stay after Fontan Procedure

Cox

Hart

Hersey

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Patients following the Fontan procedure have a physiology that results in prolonged pleural effusion, often delaying hospital discharge. The hospital length of stay (LOS) of patients following the Fontan procedure at our institution was significantly longer than the Society of Thoracic Surgery benchmark. This quality improvement project aimed to decrease hospital LOS in patients following the Fontan procedure from a baseline of 23 days to 7 days by January 1, 2021, and sustain indefinitely. Methods: We implemented standardized postoperative clinical practice guidelines in April 2020. We designed guidelines using previously published protocols. Key features included an ambulatory PleurX drain (BD, Franklin Lakes, N.J.), diuresis with fluid restriction, and pulmonary vasodilation with supplemental oxygen and sildenafil. All patients were discharged from the hospital with a PleurX drain in place. We compared clinical outcome variables before and after guideline implementation. As a balancing measure, we tracked 30-day readmissions. Results: One hundred seven patients underwent the Fontan procedure before guideline implementation from January 2015 to January 2020, with an average hospital LOS of 23 days. Postguideline implementation, 35 patients underwent the Fontan procedure from April 2020 to July 2022, with an average hospital LOS of 8 days in 2020, which further improved to an average hospital LOS of 7 days. There was no change in 30-day readmission after guideline implementation (24% pre versus 23% post; P = 0.86). Conclusion: Implementing clinical practice guidelines for patients following the Fontan procedure led to an over 50% reduction in hospital LOS without increasing 30-day readmission.

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“…We surmise increased clinical focus on FO prevention, driven by recent neonatal and pediatric literature, may have contributed to less FO than previously reported in the three aforementioned neonatal studies. [1][2][3][12][13][14][15] In our study, because~ 70% of weights on POD 1 and 2 were not performed, we calculated peak ¾FO based on daily fluid intake and output, similar to Mah and Piggot [1,2], but Wilder used daily weights. [3] Comparison of these two methods for measuring ¾FO with respect to accuracy and differential impact on outcomes warnnts farther investigation.…”

Section: Endpoint[!]mentioning

confidence: 99%

Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

Bailly

Alten

Gist

et al. 2022

The Annals of Thoracic Surgery

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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

Cited by 33 publications

References 158 publications

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

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

Quality Report: Postoperative Guideline Implementation Reduces Length of Stay after Fontan Procedure

Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

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