Fluid Management Practices After Surgery for Congenital Heart Disease: A Worldwide Survey*

Abstract

Objectives: To determine common practice for fluid management after cardiac surgery for congenital heart disease among pediatric cardiac intensivists. Design: A survey consisting of 17 questions about fluid management practices after pediatric cardiac surgery. Distribution was done by email, social media, World Federation of Pediatric Intensive and Critical Care Societies website, and World Federation of Pediatric Intensive and Critical Care Societies newsletter using the electronic survey distribution and collection system Research Electronic Data Capture. Setting: PICUs around the world. Subjects: Pediatric intensivists managing children after surgery for congenital heart disease. Interventions: None. Measurements and Main Results: One-hundred eight responses from 18 countries and six continents were received. The most common prescribed fluids for IV maintenance are isotonic solutions, mainly NaCl 0.9% (42%); followed by hypotonic fluids (33%) and balanced crystalloids solutions (14%). The majority of the respondents limit total fluid intake to 50% during the first 24 hours after cardiac surgery. The most frequently used fluid as first choice for resuscitation is NaCl 0.9% (44%), the second most frequent choice are colloids (27%). Furthermore, 64% of respondents switch to a second fluid for ongoing resuscitation, 76% of these choose a colloid. Albumin 5% is the most commonly used colloid (61%). Almost all respondents (96%) agree there is a need for research on this topic. Conclusions: Our survey demonstrates great variation in fluid management practices, not only for maintenance fluids but also for volume resuscitation. Despite the lack of evidence, colloids are frequently administered. The results highlight the need for further research and evidence-based guidelines on this topic.

Hemodynamic Response to Fluid Boluses for Hypotension in Children in a Cardiac ICU

“…The lack of information about the hemodynamic effects of FB therapy in critically ill children and especially those after cardiac surgery is problematic. This is because such FB therapy is extremely common, and variability in practice exists (5). Thus, its administration should logically occur only if there is, at least, physiologic evidence of efficacy in modifying the hemodynamic status of FB-treated children in a favorable direction.…”

Postoperative dysnatremia in infants after open‐heart surgery occurs frequently and is associated with prolonged intensive care length of stay

“…As can be seen, the amount of free water administered on POD0 was significantly higher among infants with hyponatremia as well as those developing both hyper‐/hyponatremia within 48 h. Routine administration of hypotonic in comparison with isotonic maintenance fluid has been widely discussed recently, as the administration of hypotonic crystalloids has been associated with a higher risk of developing hyponatremia both in surgical and nonsurgical patients 20–22 . This has led to a shift in maintenance fluid recommendations in critically ill children toward isotonic or near‐isotonic fluids due to the risk of hyponatremia, 23,24 while no recommendations have been made for neonates or pediatric patients, in general, undergoing cardiac surgery 24–27 . Quite interestingly, in a previous study comprising only neonates, who are considered more susceptible to hyponatremia, an administration of more than 6.5 ml/kg/h of free water during surgery led to the development of postoperative hypernatremia 28 .…”

Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review

“…The post-operative period is more often characterized by fluid accumulation than hypovolemia; therefore, according to a worldwide survey, most pediatric intensivists usually limit total fluid intake to 50% during the first 24 h after cardiac surgery, despite a lack of evidence on what extent of fluid restriction may be sufficient [ 55 ].…”