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Fluid Management Practices After Surgery for Congenital Heart Disease: A Worldwide Survey
Jan Hanot1, Adil R Dingankar2, V Ben Sivarajan2,3
1Department of Pediatrics, Pediatric Critical Care, MUMC+, Maastricht, The Netherlands.
Insights
Pediatric cardiac intensivists show varied fluid management practices post-surgery for congenital heart disease. There is a significant need for evidence-based guidelines due to inconsistent fluid choices and frequent colloid use without clear evidence.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Fluid Physiology
Background:
- Fluid management is critical in pediatric patients following cardiac surgery for congenital heart disease.
- Current practices among pediatric cardiac intensivists lack standardization, potentially impacting patient outcomes.
Purpose of the Study:
- To investigate current fluid management strategies employed by pediatric cardiac intensivists globally after congenital heart disease surgery.
- To identify common practices and variations in fluid administration for maintenance and resuscitation.
Main Methods:
- A global survey of 17 questions was distributed electronically to pediatric intensivists.
- Data were collected via Research Electronic Data Capture from 108 respondents across 18 countries.
Main Results:
- Significant variation exists in the choice of intravenous maintenance fluids, with isotonic solutions (NaCl 0.9%) being most common, followed by hypotonic fluids.
- For resuscitation, NaCl 0.9% is the preferred first choice, with colloids frequently used as a second-line agent, particularly Albumin 5%.
- A majority of respondents limit fluid intake to 50% in the first 24 hours post-surgery.
Conclusions:
- Current fluid management practices after pediatric cardiac surgery for congenital heart disease are highly variable.
- The frequent use of colloids, despite limited evidence, underscores the need for further research.
- Development of evidence-based guidelines is essential to standardize care and improve patient outcomes.
Objectives:
To determine common practice for fluid management after cardiac surgery for congenital heart disease among pediatric cardiac intensivists.
Design:
A survey consisting of 17 questions about fluid management practices after pediatric cardiac surgery. Distribution was done by email, social media, World Federation of Pediatric Intensive and Critical Care Societies website, and World Federation of Pediatric Intensive and Critical Care Societies newsletter using the electronic survey distribution and collection system Research Electronic Data Capture.
Setting:
PICUs around the world.
Subjects:
Pediatric intensivists managing children after surgery for congenital heart disease.
Interventions:
None.
Measurements And Main Results:
One-hundred eight responses from 18 countries and six continents were received. The most common prescribed fluids for IV maintenance are isotonic solutions, mainly NaCl 0.9% (42%); followed by hypotonic fluids (33%) and balanced crystalloids solutions (14%). The majority of the respondents limit total fluid intake to 50% during the first 24 hours after cardiac surgery. The most frequently used fluid as first choice for resuscitation is NaCl 0.9% (44%), the second most frequent choice are colloids (27%). Furthermore, 64% of respondents switch to a second fluid for ongoing resuscitation, 76% of these choose a colloid. Albumin 5% is the most commonly used colloid (61%). Almost all respondents (96%) agree there is a need for research on this topic.
Conclusions:
Our survey demonstrates great variation in fluid management practices, not only for maintenance fluids but also for volume resuscitation. Despite the lack of evidence, colloids are frequently administered. The results highlight the need for further research and evidence-based guidelines on this topic.
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