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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...
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Predicting fluid responsiveness in children: a systematic review.

Heng Gan1, Maxime Cannesson, John R Chandler

  • 1From the *Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia; †Department of Anesthesia, BC Children's Hospital, Vancouver, Canada; ‡Department of Anesthesiology and Perioperative Care, University of California, Irvine, School of Medicine, Irvine, California; and §Department of Anaesthesia, University College London Trust, London, United Kingdom.

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Predicting fluid responsiveness in children is challenging. Respiratory variation in aortic blood flow peak velocity is the only reliable predictor, while static and arterial blood pressure-based dynamic variables are not effective.

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Area of Science:

  • Pediatric critical care medicine
  • Hemodynamics
  • Fluid resuscitation

Background:

  • Fluid administration is key for hemodynamic resuscitation, but not all children respond.
  • Excessive fluid can be harmful, making accurate prediction of fluid responsiveness crucial.
  • Existing dynamic variables, effective in adults, lack consensus for pediatric use.

Purpose of the Study:

  • To systematically review evidence on predictors of fluid responsiveness in pediatric patients.
  • To identify reliable hemodynamic variables for guiding fluid therapy in children.

Main Methods:

  • Systematic literature search of PubMed and EMBASE (1947-2013).
  • Inclusion of studies on pediatric subjects (infants, children, adolescents).
  • Data extraction focused on variables with receiver operating characteristic curve area significantly above 0.5.

Main Results:

  • Twelve studies analyzed 501 fluid boluses in 438 pediatric patients.
  • Respiratory variation in aortic blood flow peak velocity was the only variable consistently predictive across multiple studies.
  • Static variables and dynamic variables based on arterial blood pressure or plethysmography were generally not predictive.

Conclusions:

  • Respiratory variation in aortic blood flow peak velocity is the sole validated predictor of fluid responsiveness in children.
  • Static variables are unreliable in children, mirroring adult evidence.
  • Dynamic arterial blood pressure-based variables are not predictive in children; plethysmography data is inconclusive.