Albumin 5% Versus Crystalloids for Fluid Resuscitation in Children After Cardiac Surgery
Adil R Dingankar1, Dominic A Cave, Vijay Anand1,2
1Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Insights
Crystalloids, not albumin, reduced fluid intake and pediatric cardiac intensive care unit (ICU) stay in children after cardiac surgery. Albumin offered no clinical benefit and increased costs.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Fluid resuscitation strategies
Background:
- Fluid resuscitation is critical for pediatric patients post-cardiac surgery.
- The choice between colloids (e.g., albumin) and crystalloids impacts patient outcomes.
- Optimizing fluid management can reduce complications and resource utilization.
Purpose of the Study:
- To compare the clinical effectiveness of crystalloids versus albumin 5% for fluid resuscitation in pediatric cardiac surgery patients.
- To evaluate the impact of fluid strategy on postoperative outcomes, including fluid balance and length of stay.
- To determine if albumin offers a clinical benefit over crystalloids in this population.
Main Methods:
- Retrospective cohort study comparing patients before and after a fluid policy change.
- Intervention: Shift from albumin 5% to crystalloids as the primary resuscitation fluid.
- Data collected on fluid intake, vasoactive therapy, renal replacement, ventilation, and length of stay.
Main Results:
- Crystalloid group showed significantly less fluid intake on postoperative days 2 and 3, and within the first 48 hours.
- Pediatric cardiac ICU length of stay was shorter in the crystalloid group.
- No significant differences were observed in time to negative fluid balance, need for renal replacement therapy, mechanical ventilation, or survival.
Conclusions:
- Albumin 5% did not reduce fluid intake or provide clinical benefits in pediatric cardiac surgery patients.
- Crystalloids are a more effective fluid strategy, leading to reduced fluid administration and shorter ICU stays.
- Switching to crystalloids avoids potential side effects and reduces healthcare costs associated with albumin use.
Objectives:
To determine the clinical benefit of using colloids versus crystalloids for volume resuscitation in children admitted after cardiac surgery.
Design:
Retrospective pre-/postintervention cohort study.
Setting:
Stollery Children's Hospital tertiary care pediatric cardiac ICU.
Patients:
Children admitted to the pediatric cardiac ICU after cardiac surgery.
Interventions:
Fluid resuscitation policy change in which crystalloids replaced albumin 5% as the primary fluid strategy for resuscitation after cardiac surgery.
Measurements And Main Results:
Children who underwent cardiac surgery in the 6 months prior to the policy change (5% albumin group) were compared with children admitted during the 6 months after (crystalloid group). Demographic, perioperative, and outcome variables (fluid intake days 1-4 postoperative, vasoactive therapy, blood products, time to negative fluid balance, renal replacement therapies, mechanical ventilation, pediatric cardiac ICU, and length of stay) were collected. Data were analyzed using linear and logistic multivariate analysis. The study included 360 children. There was no association between fluid group and fluid intake (mL/kg) on day 1 postoperatively (coefficient, 2.84; 95% CI, 5.37-11.05; p = 0.497). However, crystalloid group was associated with significantly less fluid intake on day 2 (coefficient, -12.8; 95% CI, -22.0 to -3.65; p = 0.006), day 3 (coefficient, -14.9; 95% CI, -24.3 to -5.57; p = 0.002), and on the first 48 hours postoperative (coefficient, 10.1; 95% CI, -27.9 to -1.29; p = 0.032). Pediatric cardiac ICU stay (coefficient, -1.29; 95% CI, -2.50 to -0.08; p = 0.036) was shorter for the crystalloid group. There were no significant differences in the time to negative balance, need for renal replacement therapy, mechanical ventilation days, hospital stay, or pediatric cardiac ICU survival.
Conclusions:
In our study, the use of albumin 5% for resuscitation after cardiac surgery was not associated with less fluid intake but rather the opposite. Albumin administration did not provide measured clinical benefit while exposing children to side effects and generating higher costs to the healthcare system.
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