Recent developments in the perioperative fluid management for the paediatric patient

Paut, O.; Lacroix, Frédéric

doi:10.1097/01.aco.0000192818.68730.9d

Cited by 75 publications

(37 citation statements)

References 50 publications

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“…This third space seems to start slowly redistributing around the third day after the surgery, contributing to the maintenance of a hypervolemic state. In addition, although these patients usually have a preserved renal function, the postoperative period is characterized by a rise in blood levels of antidiuretic hormone, 18 which promotes water retention and hemodilution and therefore delays the correction of the volemic status.…”

Section: Discussionmentioning

confidence: 99%

Association of postoperative furosemide use with a reduced blood transfusion rate in sagittal craniosynostosis surgery

Harroud¹,

Weil²,

Turgeon

et al. 2016

PED

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OBJECT A major challenge in sagittal craniosynostosis surgery is the high transfusion rate (50%–100%) related to blood loss in small pediatric patients. Several approaches have been proposed to prevent packed red blood cell (PRBC) transfusion, including endoscopic surgery, erythropoietin ortranexamic acid administration, and preoperative hemodilution. The authors hypothesized that a significant proportion of postoperative anemia observed in pediatric patients is actually dilutional. Consequently, since 2005, at CHU Sainte-Justine, furosemide has been administered to correct the volemic status and prevent PRBC transfusion. The purpose of this study was to evaluate the impact of postoperative furosemide administration on PRBC transfusion rates. METHODS This was a retrospective study of 96 consecutive patients with sagittal synostosis who underwent surgery at CHU Sainte-Justine between January 2000 and May 2012. The mean age at surgery was 4.9 ± 1.5 months (range 2.8–8.7 months). Patients who had surgery before 2005 constituted the control group. Those who had surgery in 2005 or 2006 were considered part of an implementation phase because furosemide administration was not routine. Patients who had surgery after 2006 were part of the experimental (or furosemide) group. Transfusion rates among the 3 groups were compared. The impact of furosemide administration on transfusion requirement was also measured while accounting for other variables of interest in a multiple logistic regression model. RESULTS The total transfusion rate was significantly reduced in the furosemide group compared with the control group (31.3% vs 62.5%, respectively; p = 0.009), mirroring the decrease in the postoperative transfusion rate between the groups (18.3% vs 50.0%, respectively; p = 0.003). The postoperative transfusion threshold remained similar throughout the study (mean hemoglobin 56.0 g/dl vs 60.9 g/dl for control and furosemide groups, respectively; p = 0.085). The proportion of nontransfused patients with recorded hemoglobin below 70 g/dl did not differ between the control and furosemide groups (41.7% vs 28.6%, respectively; p = 0.489). Surgical procedure, preoperative hemoglobin level, estimated blood loss, and furosemide administration significantly affected the risk of receiving a postoperative PRBC transfusion. When these variables were analyzed in a multiple logistic regression model, furosemide administration remained strongly associated with a reduced risk of being exposed to a blood transfusion (OR 0.196, p = 0.005). There were no complications related to furosemide administration. CONCLUSIONS A significant part of the postoperative anemia observed in patients who underwent sagittal craniosynostosis surgery was due to hypervolemic hemodilution. Correction of the volemic status with furosemide administration significantly reduces postoperative PRBC transfusion requirements in these patients.

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Section: Discussionmentioning

confidence: 99%

Association of postoperative furosemide use with a reduced blood transfusion rate in sagittal craniosynostosis surgery

Harroud¹,

Weil²,

Turgeon

et al. 2016

PED

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“…Hyperglycemia has been shown to be a negative prognostic indicator in children with traumatic brain injury, and is associated with reduced immune function and increased mortality in burn patients. 46 In a retrospective cohort study, early and prolonged hyperglycemia was found to be associated with a 3-and 6-fold increased risk of mortality, respectively, in critically ill children. 45 The incidence of hypoglycemia is not as common as previously thought, in an era where the amount of glucose administration has significantly decreased.…”

Section: Glucose During Maintenance Fluid Therapymentioning

confidence: 99%

Manutenção parenteral de líquidos na criança agudamente doente

Choong

Bohn

2007

J. Pediatr. (Rio J.)

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Objective: To examine electrolyte-free water requirements that should be considered when administering maintenance fluids in a critically ill child. We examine some of the difficulties in estimating these requirements, and discuss the controversies with respect to the traditional recommendations.Sources: MEDLINE (1966MEDLINE ( -2007, Embase , and the Cochrane Library, using the terms: "fluid therapy", "hypotonic", "isotonic solution", and synonyms or related terms. Summary of the findings:The ideal maintenance solution and fluid regimen remains a topic of heated debate in pediatrics. The traditional recommendations for maintenance fluids are increasingly criticized as they do not consistently apply in acute illness, where energy expenditure and electrolyte requirements deviate significantly from the original estimates. A physiologically based framework for prescribing maintenance fluids is presented, with the objective of maintaining tonicity balance, and infusing the minimum volume of maintenance fluid required to maintain hemodynamics. Indications for isotonic and hypotonic solutions are discussed. Conclusions: Maintenance fluid prescriptions should be individualized. No single intravenous solution is ideal forevery child during all phases of illness, but there is evidence to suggest that the safest empirical choice is an isotonic solution. Hypotonic solutions should only be considered if the goal is to achieve a positive free-water balance. Critically ill children may require a reduction by as much as 40-50% of the currently recommended maintenance volumes. All patients receiving intravenous fluids should be monitored closely with daily weights, fluid balances, biochemical and clinical parameters in order to best guide this therapy.J Pediatr (Rio J). 2007;83(2 Suppl):S3-10: Fluid therapy, fluid maintenance, blood, electrolytes, isotonic solution.

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“…Intraoperative glucose is no longer required in the maintenance fluid for the majority of children 1,19,30 The one group where there is uncertainty is the neonate.…”

Section: Should Maintenance Fluid Contain Glucose?mentioning

confidence: 99%

“…36 The worries concerning neonatal hypoglycaemia have tended to inform practice, so that glucose-containing solutions are used for maintenance in neonates, particularly when the neonate has an infusion of glucose or parenteral nutrition in the immediate preoperative period. 30 The normal glucose infusions used have concentrations ranging from 5% to 10%. These solutions may produce hyperglycaemia, which concern some.…”

Section: Should Maintenance Fluid Contain Glucose?mentioning

confidence: 99%