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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

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Delphi Process for Validation of Fluid Treatment Algorithm for Critically Ill Pediatric Trauma Patients.

Vincent Duron¹, Nicholas Schmoke¹, Rika Ichinose¹

¹Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.

The Journal of Surgical Research

|December 10, 2023

Summary

Pediatric trauma patients benefit from a new fluid management algorithm that prioritizes de-escalating intravenous fluids to minimize complications. This consensus-based approach ensures expert agreement on optimal crystalloid resuscitation strategies.

Keywords:

Critical care Extracellular fluid Infusions Intravenous Pediatrics Trauma

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Area of Science:

Pediatric Critical Care
Trauma Resuscitation
Fluid Management

Background:

Intravenous fluid therapy is crucial for pediatric trauma patients but aggressive resuscitation carries risks.
Optimal crystalloid resuscitation strategies and fluid phase transitions lack consensus.
Minimizing iatrogenic complications from fluid therapy is a key concern.

Purpose of the Study:

To develop and validate a consensus-based algorithm for intravenous fluid management in pediatric trauma.
To establish clear guidelines for fluid resuscitation de-escalation in this population.

Main Methods:

A three-round Delphi process involving 14 pediatric trauma, critical care, and emergency medicine experts.
Online surveys and live video conferences were used to achieve expert consensus.
Algorithm parameters were accepted if >75% agreed or rejected if >50% disagreed.

Main Results:

Initial expert agreement was 64%, increasing to 90% after round 2.
The final revised algorithm achieved 100% acceptance from all participating experts.
Fourteen experts from five Level 1 pediatric trauma centers participated.

Conclusions:

A validated algorithm for fluid management in pediatric trauma patients has been developed.
The algorithm emphasizes de-escalation of intravenous fluids to reduce iatrogenic complications.
This consensus-driven approach provides a standardized method for fluid therapy in pediatric trauma.