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Is there a benefit to postoperative fluid restriction following infant surgery?
George T Nicholson1, Martha L Clabby, William T Mahle
1Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga., USA.
Insights
Achieving a negative fluid balance after infant heart surgery does not shorten mechanical ventilation or hospital stays. This study questions the effectiveness of fluid restriction in pediatric cardiac intensive care units.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Fluid Management
Background:
- Fluid restriction is a common practice post-pediatric cardiac surgery to reduce edema and facilitate extubation.
- The theoretical benefit of early negative fluid balance in infants undergoing palliative shunt surgery requires clinical validation.
Purpose of the Study:
- To investigate the association between the time to achieve negative fluid balance and outcomes in neonates after systemic-to-pulmonary artery shunt palliation.
- To determine if fluid restriction impacts mechanical ventilation duration and hospital length of stay.
Main Methods:
- Retrospective analysis of neonates undergoing modified systemic-to-pulmonary artery shunt.
- Data collected included time to negative fluid balance, pediatric cardiac intensive care unit (CICU) and hospital length of stay.
- Analysis focused on 65 subjects from a single institution between 2009 and 2011.
Main Results:
- The mean time to achieve negative fluid balance was 25.0 ± 12.8 hours.
- No significant association was found between time to negative fluid balance and duration of mechanical ventilation.
- Hospital length of stay and CICU stay were not impacted by the time to negative fluid balance.
Conclusions:
- Time to negative fluid balance is not a significant predictor of mechanical ventilation duration or hospital length of stay in infants post-shunt palliation.
- The clinical utility of aggressive fluid restriction strategies immediately after infant heart surgery remains uncertain.
- Further research may be needed to optimize fluid management protocols in this vulnerable population.
Objective:
Fluid restriction is often employed immediately following cardiac surgery in children. The goal of this approach is to achieve an early negative fluid balance, which theoretically should lead to less interstitial edema and earlier extubation. The purpose of this study was to determine whether time to negative fluid balance in infants after undergoing systemic-to-pulmonary artery shunt palliation impacts duration of mechanical ventilation and hospital length of stay.
Design:
This is a retrospective study of neonates who underwent a modified systemic-to-pulmonary artery shunt at a single institution.
Setting:
University hospital pediatric cardiac intensive care unit (CICU).
Patients:
Neonates who underwent a modified systemic-to-pulmonary artery shunt between January 1, 2009 and June 1, 2011.
Outcome Measures:
Information collected included time to negative fluid balance (in hours), CICU and hospital length of stay (in days), and the number of patients who had delayed sternal closure and/or underwent cardiopulmonary bypass.
Results:
Data were available for 65 subjects. Median fluid administration in the 24 hours postoperatively was 43.9 cc/kg/day (interquartile range: 32.9-61.0). Mean time to negative fluid balance was 25.0 ± 12.8 hours. Time to negative fluid balance was not associated with time to extubation, CICU and hospital length of stay, or change in weight-for-age z-score at intensive care unit discharge.
Conclusion:
Time to negative fluid balance is not associated with duration of mechanical ventilation, CICU, and hospital length of stay in patients after undergoing systemic-to-pulmonary artery shunt palliation. The utility of a restricted fluid strategy immediately following infant heart surgery is questionable.
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