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Postoperative Hydration in Children Using Intermittent Boluses of Balanced Salt Solution: Results of a Randomized
William R Johnston1, Allison L Mak Croughan2, Rosa Hwang2
1General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Postoperative intravenous fluid boluses of balanced salt solution are safe and feasible, significantly reducing fluid administration compared to continuous infusions. This approach offers a more physiologic and comfortable alternative for pediatric surgical patients.
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.
Background:
Postoperative maintenance fluids are traditionally provided via hypotonic dextrose containing fluids administered intravenously by continuous infusion. We hypothesized that scheduled weight-based boluses of balanced salt solution would be more physiologic, reduce fluid volumes, and improve patient comfort.
Methods:
As part of an IRB-approved randomized controlled trial (Boluses of Ringer's in Surgical Kids, BRiSK), we randomized patients aged 1-21 years undergoing elective abdominal or thoracic surgery to post-operatively receive weight-based D50.45NS+20mEq/L KCl at a continuous rate or intermittent boluses of Lactated Ringer's solution until oral liquid toleration. Patients with nephropathy, diabetes, or receiving parenteral nutrition were excluded. We analyzed electrolytes, urine output, fluid volume, and adverse events.
Results:
We enrolled and randomized 60 patients: 29 to continuous fluids and 31 to bolus fluids. One patient from the bolus group dropped out. No patients crossed over due to difficulties with application of the bolus protocol. There were no baseline differences between groups with a mean age of 12.6 ± 1.4yr and weight of 50.9 ± 7.2 kg. There were no serious adverse events or electrolyte disturbances in either group. Patients in the bolus group received significantly less total fluid than those in the continuous group (0.43 mL/kg/h vs 1.1 mL/kg/h, p < 0.001) with no difference in urine output [1.4 ± 0.2 mL/kg/h vs 1.6 ± 0.3 mL/kg/h, p = 0.211]. There were two episodes of mild hypoglycemia in the bolus group compared to seven episodes of mild hyperglycemia in the continuous group.
Conclusions:
Administration of post-operative intravenous fluids as boluses of balanced salt solution is feasible, safe, and results in significantly less fluid administered compared to a traditional continuous protocol.
Level Of Evidence:
II.
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