High volume crystalloid resuscitation adversely affects pediatric trauma patients

Coons, Barbara E.; Tam, Sophia F.; Rubsam, Jeanne; Stylianos, Steven; Duron, Vincent

doi:10.1016/j.jpedsurg.2018.07.009

Cited by 42 publications

(34 citation statements)

References 16 publications

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“…Evidence relating to intraoperative fluid volume administration includes a prospective study of 23 children less than 3 years old undergoing abdominal surgery where omitting replacement of interstitial fluid loss (estimated at 5 mL/kg/h) led to increased need for fluid bolus and negative base deficit without effect on time to return of bowel function . In pediatric trauma patients, increased fluid administration is associated with increased ventilator days, ICU stay, time fasting, and overall hospital LOS . The limited data on ERAS implementation with fluid restriction for pediatric patients have demonstrated improved outcomes including decreased LOS and improvement in bowel function without any associated complications …”

Section: Discussionmentioning

confidence: 99%

The association between high‐volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection

Sanford

Zurakowski

Litvinova

et al. 2019

Pediatric Anesthesia

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Background: Traditional intraoperative fluid administration practices have been challenged this century with data suggesting improved outcomes with restrictive or goal-directed fluid administration during adult bowel surgery. Minimal data on outcomes associated with differing intraoperative fluid administration practice exists for pediatric patients. Aims:We assessed factors and outcomes associated with high-volume fluid administration in pediatric patients undergoing colectomy. We hypothesized that high-volume fluid administration is associated with impaired recovery and, thus, increased length of stay. Methods:A database of perioperative practice and postoperative outcomes at a tertiary pediatric hospital was queried for colectomy encounters between July 2012 and March 2017. Data extracted included patient characteristics, perioperative clinical data, and postoperative outcomes. Encounters were stratified into two groups: greater than 90th percentile fluids administered (high-volume fluid administration group) vs less than 90th percentile fluids administered. Univariable tests, multivariable logistic regression, and propensity score matched group comparisons were used to asses outcomes associated with high-volume fluid administration. Results:A total of 209 colectomy encounters were identified from which 12 were excluded based on predetermined criteria. High-volume fluid administration was associated with length of stay >6 days (AOR 8.14, CI 1.75-37.8, P = 0.007), time to first meal >4 days (AOR of 5.91, CI 1.30-27.17, P = 0.02), and supplemental oxygen requirement >24 hours (AOR 3.60, CI 1.25-10.39, P = 0.02) after adjusting for ASA status, blood loss, transfusion, and open surgery. Similarly, propensity score matched patients with high-volume fluid administration vs controls were more likely to have length of stay >6 days (93% vs 54%, P = 0.007), time to first meal >4 days (93% vs 57%, P = 0.009), and supplemental oxygen requirement >24 hours (36% vs 12%, P = 0.033). Conclusion:High-volume fluid administration during colectomy for pediatric patients is associated with worsened postoperative outcomes suggestive of impaired recovery.

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Section: Discussionmentioning

confidence: 99%

The association between high‐volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection

Sanford

Zurakowski

Litvinova

et al. 2019

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…Six retrospective pediatric studies were identified. 41 , 42 , 43 , 44 , 45 , 46 All were derived from trauma registries. Only 1 study assessed the volume of fluid given to children with traumatic injuries in the prehospital setting.…”

Section: Pals: Recognition and Prearrest Treatments For Shockmentioning

confidence: 99%

“…Only 1 study assessed the volume of fluid given to children with traumatic injuries in the prehospital setting. 41 Four studies compared the total crystalloid volume given in 24 hours, 42 , 44 , 45 , 46 and 1 study assessed the volume of crystalloid given to patients needing transfusion. 43 The study that reported the critical outcome of survival to 24 hours 41 found no benefit to survival associated with graded/“limited” volume compared with standard care for trauma resuscitation.…”

Section: Pals: Recognition and Prearrest Treatments For Shockmentioning

confidence: 99%

“…For the critical outcome of survival to discharge, 4 studies found no benefit associated with graded/limited volume administration compared with standard care. 41 , 44 , 46 , 47 One study reported lower survival to hospital discharge associated with high-volume crystalloid administration (greater than 60 mL/kg per 24 hours) compared with low- and moderate-volume crystalloid administration (ie, 0–40 mL/kg per 24 hours or 40–60 mL/kg per 24 hours), 42 and 1 reported lower survival rates associated with higher transfusion volumes (ie, greater than 50 mL/kg per 24 hours compared with those receiving 150 mL/kg or less per 24 hours). 43 Five studies reported an increased hospital or intensive care length of stay associated with higher crystalloid volume administration in the first 24 hours.…”

Section: Pals: Recognition and Prearrest Treatments For Shockmentioning

confidence: 99%

“… 43 Five studies reported an increased hospital or intensive care length of stay associated with higher crystalloid volume administration in the first 24 hours. 42 , 43 , 44 , 46 , 47 All studies were retrospective, and they reported different interventions on differing patient populations and differing associated outcomes. Although it is difficult to compare results, there is a suggestion of a possible advantage of using limited volume resuscitation.…”

Section: Pals: Recognition and Prearrest Treatments For Shockmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Life Support

Maconochie¹,

Aickin²,

Hazinski³

et al. 2020

Resuscitation

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.

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Massive Transfusion in the Pediatric Trauma Patient

Rauh

Neff²

2022

Pediatric Trauma Care

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High volume crystalloid resuscitation adversely affects pediatric trauma patients

Cited by 42 publications

References 16 publications

The association between high‐volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection

The association between high‐volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection

Pediatric Life Support

Massive Transfusion in the Pediatric Trauma Patient

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