Intermittent boluses of balanced salt solution for post-operative intravenous hydration following elective major abdominal and thoracic surgery in children.

Autor: Johnston WR; General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA.; Hospital of the University of Pennsylvania, Philadelphia, PA, USA., Hwang R; General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA., Mattei P; General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA. mattei@chop.edu.
Jazyk: angličtina
Zdroj: Pediatric surgery international [Pediatr Surg Int] 2022 Apr; Vol. 38 (4), pp. 573-579. Date of Electronic Publication: 2022 Feb 28.
DOI: 10.1007/s00383-022-05081-7
Abstrakt: Purpose: Maintenance fluids following major operations in children are typically administered with a continuous rate. We hypothesized that administering fluids as intermittent boluses is more physiologic and could limit post-operative fluid volume, thereby avoiding harmful effects of excess fluid.
Methods: We retrospectively reviewed children aged 1-21 admitted after an elective major abdominal or thoracic operation from 2015 to 2021. We excluded non-elective operations and patients receiving peri-operative enteral or parenteral nutrition. We analyzed total fluid volume at 0-24, 24-48, 48-72, and 72-96 h, time to regular diet and discharge, and end-organ complications.
Results: We identified 363 patients, of which 108 received intermittent boluses and 255 continuous fluids. Bolus group patients received significantly less fluid up to 72 h post-operatively with average rates of 0.49 mL/kg/h vs 0.86 mL/kg/h at 0-24 h (p << 0.01), 0.57 mL/kg/h vs 1.46 mL/kg/h at 24-48 h (p << 0.01), and 0.50 vs 0.92 mL/kg/h at 48-72 h (p << 0.01). Additionally, the bolus group maintained adequate urine output, tolerated a regular diet sooner (2.08 days vs 2.51 days; p = 0.0023) and averaged a shorter hospital stay (3.12 vs 4.14 days; p = 0.004). There was no difference in adverse effects between the two groups.
Conclusion: Utilizing intermittent boluses reduces the volume of maintenance fluids administered and may lead to a faster time to regular diet and discharge.
Level of Evidence: IV.
Type of Study: Retrospective review.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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