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Intermittent boluses of balanced salt solution for post-operative intravenous hydration following elective major
William R Johnston1,2, Rosa Hwang1, Peter Mattei3
1General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA.
Insights
Intermittent bolus IV fluids in children after major surgery reduce total fluid volume and may speed recovery. This approach is physiologic and avoids excess fluid without increasing adverse effects.
Area of Science:
- Pediatric surgery
- Intravenous fluid therapy
- Postoperative care
Background:
- Continuous intravenous (IV) fluids are standard for children post-major surgery.
- This practice may lead to excessive fluid administration and potential complications.
- An alternative, more physiologic approach is intermittent bolus fluid administration.
Purpose of the Study:
- To test the hypothesis that intermittent bolus IV fluids are more physiologic than continuous fluids in pediatric surgical patients.
- To determine if intermittent bolus fluids limit post-operative fluid volume and reduce associated harmful effects.
- To compare fluid volumes, recovery times, and complications between intermittent bolus and continuous fluid groups.
Main Methods:
- Retrospective review of 363 children (aged 1-21) undergoing elective major abdominal or thoracic surgery.
- Exclusion of non-elective cases and patients receiving enteral/parenteral nutrition.
- Analysis of total fluid volume, time to diet/discharge, and end-organ complications at specific postoperative intervals (0-96 hours).
Main Results:
- Patients receiving intermittent bolus fluids received significantly less IV fluid up to 72 hours postoperatively compared to the continuous group.
- The bolus group showed adequate urine output and tolerated a regular diet sooner (2.08 vs 2.51 days).
- The bolus group also had a shorter hospital stay (3.12 vs 4.14 days) with no significant difference in adverse effects.
Conclusions:
- Intermittent bolus IV fluid administration effectively reduces the volume of maintenance fluids in pediatric surgical patients.
- This method may promote faster recovery, indicated by earlier tolerance of a regular diet and shorter hospital discharge times.
- The findings support intermittent bolus fluids as a potentially safer and more efficient postoperative fluid management strategy in children.
Purpose:
Maintenance fluids following major operations in children are typically administered with a continuous rate. We hypothesized that administering fluids as intermittent boluses is more physiologic and could limit post-operative fluid volume, thereby avoiding harmful effects of excess fluid.
Methods:
We retrospectively reviewed children aged 1-21 admitted after an elective major abdominal or thoracic operation from 2015 to 2021. We excluded non-elective operations and patients receiving peri-operative enteral or parenteral nutrition. We analyzed total fluid volume at 0-24, 24-48, 48-72, and 72-96 h, time to regular diet and discharge, and end-organ complications.
Results:
We identified 363 patients, of which 108 received intermittent boluses and 255 continuous fluids. Bolus group patients received significantly less fluid up to 72 h post-operatively with average rates of 0.49 mL/kg/h vs 0.86 mL/kg/h at 0-24 h (p << 0.01), 0.57 mL/kg/h vs 1.46 mL/kg/h at 24-48 h (p << 0.01), and 0.50 vs 0.92 mL/kg/h at 48-72 h (p << 0.01). Additionally, the bolus group maintained adequate urine output, tolerated a regular diet sooner (2.08 days vs 2.51 days; p = 0.0023) and averaged a shorter hospital stay (3.12 vs 4.14 days; p = 0.004). There was no difference in adverse effects between the two groups.
Conclusion:
Utilizing intermittent boluses reduces the volume of maintenance fluids administered and may lead to a faster time to regular diet and discharge.
Level Of Evidence:
IV.
Type Of Study:
Retrospective review.
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