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Focused Review of Enhanced Recovery After Abdominal Trauma Surgery in the Pediatric Population and Development of a
Robert P Moore1, Niharika Singh2, Madelyn Wang3
1Dept of Anesthesia, Stony Brook University Hospital, Stony Brook, New York, USA.
Insights
Developing an enhanced recovery after surgery (ERAS) pathway for pediatric abdominal trauma surgery is crucial. This pathway incorporates evidence-based elements to improve outcomes for children undergoing surgery for traumatic injuries.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Enhanced Recovery Pathways
Background:
- Traumatic injuries are a leading cause of death and disability in children.
- Enhanced recovery after surgery (ERAS) pathways are effective in adults but understudied in pediatric trauma.
- There is a lack of consensus guidelines for pediatric post-trauma surgery care.
Purpose of the Study:
- To systematically search for existing pediatric enhanced recovery after trauma surgery pathways.
- To identify key elements from adult and pediatric literature for a potential pediatric pathway.
Main Methods:
- Systematic literature search for pediatric enhanced recovery after trauma surgery pathways.
- Review of pediatric and adult trauma ERAS literature.
Main Results:
- No established pediatric enhanced recovery after trauma surgery pathways were identified.
- The literature supports incorporating several elements into a pediatric trauma ERAS pathway.
Conclusions:
- A proposed pediatric enhanced recovery after trauma surgery pathway is presented.
- Key elements include multimodal analgesia, goal-directed fluid therapy, early nutrition, timely antibiotics, and patient education.
Background:
Traumatic injuries are the leading cause of morbidity and mortality amongst pediatric patients; improving outcomes after pediatric abdominal trauma surgery could be quite impactful. Although enhanced recovery after surgery (ERAS) pathways have been successfully employed in adult trauma patients, there are few studies on pediatric enhanced recovery after abdominal trauma surgery and no consensus post trauma surgery guidelines for children.
Aims/Methods:
A systematic search of the existing literature for pediatric enhanced recovery after trauma surgery pathways was performed by two independent authors. However, no pediatric enhanced recovery after trauma surgery pathways were found. Therefore, we reviewed the pediatric and adult enhanced recovery after trauma surgery literature to identify potential impactful elements of care that could be part of a pediatric pathway.
Results:
The existing literature supports the incorporation of several elements into pediatric trauma ERAS pathway.
Conclusion:
We propose a pediatric enhanced recovery after trauma surgery pathway, which highlights several principles of ERAS pathways (multimodal analgesia, goal-directed fluid therapy, early initiation of nutrition, timely administration of antibiotics, avoidance of hypothermia, DVT prophylaxis, the early removal of drains and indwelling catheters, and patient education).
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