Postoperative Hydration in Children Using Intermittent Boluses of Balanced Salt Solution: Results of a Randomized...

Area of Science:

• Pediatric Surgery
• Intravenous Fluid Therapy
• Critical Care Medicine

Background:

• Traditional postoperative intravenous fluids often use hypotonic dextrose solutions via continuous infusion.
• This practice may not be the most physiologic or comfortable for patients.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of administering postoperative intravenous fluids as scheduled weight-based boluses of balanced salt solution.
• To compare this bolus method against traditional continuous infusion of hypotonic dextrose-containing fluids.

Main Methods:

• A randomized controlled trial (Boluses of Ringer's in Surgical Kids, BRiSK) involving pediatric patients (1-21 years) undergoing elective abdominal or thoracic surgery.
• Patients received either continuous D50.45NS+20mEq/L KCl or intermittent Lactated Ringer's boluses post-operatively.
• Exclusion criteria included nephropathy, diabetes, or parenteral nutrition. Electrolytes, urine output, fluid volume, and adverse events were analyzed.

Main Results:

• Sixty patients were randomized; no significant baseline differences were observed.
• The bolus group received significantly less total fluid (0.43 mL/kg/h vs 1.1 mL/kg/h, p < 0.001) without impacting urine output.
• No serious adverse events or electrolyte disturbances occurred; mild hypoglycemia was noted in the bolus group (2 episodes) versus mild hyperglycemia in the continuous group (7 episodes).

Conclusions:

• Administering postoperative intravenous fluids as intermittent boluses of balanced salt solution is a feasible and safe strategy.
• This bolus method leads to significantly reduced total fluid administration compared to traditional continuous infusion protocols.
• The findings suggest a more physiologic and potentially more comfortable fluid management approach for pediatric surgical patients.