Fluid management during pediatric lung transplantation: a single-center experience

The impact of intraoperative fluid balance on postoperative outcomes in pediatric lung transplantation (LTx) has not been conclusively established. This study aimed to investigate the effect of fluid balance on postoperative outcomes in pediatric LTx, while also sharing insights from our clinical experiences in fluid management.

We reviewed the medical records of children who underwent LTx from July 2019 to August 2023. Intraoperative data, fluid management strategies, and postoperative outcomes were recorded. Fluid overload (FO) was defined as an intraoperative fluid balance ≥10%. The patients were categorized into two groups: FO and non-FO. Differences in the incidence of primary graft dysfunction (PGD) and other outcomes were compared between these groups.

A total of 20 children were included in the study, with 12 in the FO group and 8 in the non-FO group. The analysis revealed no significant differences between the two groups regarding postoperative grade 3 PGD (P=0.35), acute kidney injury (AKI) within 48 hours after surgery (P=0.67), duration of postoperative mechanical ventilation (P=0.05), and duration of ICU stay (P=0.73). Although red blood cell (RBC) (P=0.13), fresh frozen plasma (FFP) (P=0.16), crystalloid (P=0.61) and total intake (P=0.23) were higher in the PGD group compared to the non-PGD group, these differences were not statistically significant.

The current evidence is insufficient to support the hypothesis that a non-FO approach within a restrictive fluid strategy can reduce the risk of adverse outcomes following pediatric LTx. However, this does not imply that an FO strategy should be advocated. Further high-quality clinical studies are necessary to validate these findings.