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Effects of a restrictive fluid regimen in pediatric patients undergoing major abdominal surgery
Sahatsa Mandee1, Wassana Butmangkun, Naiyana Aroonpruksakul
1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Restrictive fluid regimens are suitable for pediatric abdominal surgery, with no adverse outcomes. This approach may improve hemodynamic stability and reduce fluid administration needs in young patients.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Adult studies suggest restrictive fluid regimens improve surgical outcomes.
- Pediatric patients have different body fluid distribution, potentially altering fluid requirements.
- Perioperative fluid management in pediatric surgery requires careful consideration.
Purpose of the Study:
- To evaluate the impact of a restrictive fluid regimen versus a liberal approach in pediatric patients undergoing major abdominal surgery.
- To compare hemodynamic parameters and fluid balance between two perioperative fluid management strategies.
- To assess the safety and efficacy of restrictive fluid administration in young surgical patients.
Main Methods:
- A stratified, randomized, controlled trial involving 25 pediatric patients (mean age <3 years).
- Two groups: a control group receiving comprehensive fluid replacement and a restrictive group omitting interstitial space replacement.
- Intraoperative fluid resuscitation guided by hemodynamics and base excess; comprehensive data collection.
Main Results:
- The control group required significantly less additional fluid for resuscitation than the restrictive group (P=0.012).
- The restrictive group exhibited higher heart rates (P=0.012) and more negative base excess values (P=0.049).
- No significant differences were observed in total fluid volume, postoperative kidney function, body weight changes, or return of bowel function.
Conclusions:
- Perioperative fluid management including an estimated interstitial space replacement is appropriate for pediatric patients undergoing major abdominal surgery.
- A restrictive fluid strategy, while requiring less fluid, may lead to altered hemodynamic parameters in pediatric surgical patients.
- The study supports the suitability of a tailored fluid regimen for this population, balancing needs and outcomes.
Objective:
To investigate the effects of restrictive fluid regimen during major abdominal surgery in pediatric patients.
Background:
In adults, a restrictive and goal-directed regimen as opposed to a liberal-fluid regimen results in better outcomes after various major surgical procedures. The different ratio of body fluid distribution in pediatric patients from those of adults may influence different needs of fluid.
Methods:
This stratified, randomized, controlled trial was conducted in 25 pediatric patients (mean age <3 years) undergoing major abdominal surgery. Patients were allocated to two groups based on their perioperative fluid management. 'control group' received maintenance plus deficit plus interstitial space replacement plus ongoing loss, whereas 'restrictive group' had a similar treatment, but were given no interstitial space replacement. Intraoperative fluid resuscitation was guided by hemodynamics and base excess. Parameters recorded included hemodynamic variables, the volume and type of intravenous fluid, blood chemistry (including lactate, base excess, and electrolyte), chest X-ray, body weight, complications, and return of bowel function.
Results:
Patients in control group needed significantly less additional fluid for resuscitation compared to restrictive group (0.62 ± 3.51 ml · kg(-1) · h(-1) vs 5.04 ± 4.16 ml · kg(-1) · h(-1) ; P = 0.012). In restrictive group, heart rates were higher (P = 0.012) and base excess showed more negative results (P = 0.049). There were no differences between the groups in terms of the total volume requirement, postoperative kidney function, chest X-ray, variation of body weight and the postoperative outcomes.
Conclusions:
Volume preload corresponding with an estimated interstitial space replacement was suitable for application to pediatric patients undergoing major abdominal surgery.
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