Is There a Benefit to Postoperative Fluid Restriction Following Infant Surgery?

Nicholson, George T.; Clabby, Martha L.; Mahle, William T.

doi:10.1111/chd.12165

Cited by 10 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 Nicholson et al questioned the benefit of immediate fluid restriction for infant cardiac surgery. 20 In that study, the authors found that achieving a negative FB in 24 hours was not associated with better outcomes, such as shortened length of ICU or hospital stay. The reduction in caloric intake was significant partly because of restricted fluid intake.…”

Section: Discussionmentioning

confidence: 92%

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

Chen

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

Objectives: In addition to the association between positive fluid balance (FB) and acute kidney injury (AKI) after cardiac surgery reported by former studies, this study examined the relationship between FB and progressive AKI. Design: A retrospective, observational study. Setting: University teaching, grade A tertiary hospital in Shanghai, China. Participants: Adult patients after cardiac surgery from JulyÀDecember 2016. Interventions: Perioperative data relating to postoperative fluid intake and output were collected. AKI progression was defined as a worsening of AKI stage. FB was calculated as (fluid intake [L] À fluid output [L]/body weight [kg] £ 100%). Measurements and Main Results: The study comprised 1,522 patients. The incidences of AKI and progressive AKI were 33.1% (n = 504) and 18.1% (n = 91), respectively. There was an exponential increase between 24-hour FB and AKI occurrence, and an approximate "U"-shape association between 48-hour FB and AKI progression. Multivariate logistic regression showed that 24-hour FB 5% was an independent risk factor for AKI incidence (odds ratio [OR] 3.976; p < 0.001) and 48-hour FB <À5% or 3% was associated with an increase of AKI progression (FB <À5%, OR 7.078 [p = 0.031]; FB 3%-5%, OR 6.598 [p = 0.020]; FB 5%, OR 16.453 [p < 0.001]). Conclusions: An exponential increase was found between 24-hour FB and AKI occurrence and a "U"-shape association between 48-hour FB and AKI progression. Both excessively negative and positive accumulative 48-hour FB increased the risk of AKI progression, suggesting cautious monitoring and application of fluid load in clinical practice.

show abstract

Section: Discussionmentioning

confidence: 92%

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

Chen

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

show abstract

“…For bypass cases, fluids are restricted to 50 % of maintenance rates in the immediate postoperative period, whereas in non-bypass cases, it is limited to 60 % of maintenance rates. This fluid regimen should continue until the infant's airway is extubated, after which the fluid rate should increase by 10 % per day [103,104].…”

Section: Special Cases: Cardiac Surgerymentioning

confidence: 99%

Perioperative Metabolic Care of the Term and Preterm Infant

Frawley

Ingelmo

Lakshminrusimha

2014

Neonatal Anesthesia

View full text Add to dashboard Cite

The body composition of the fetus changes dramatically during gestation. Total body water, as a proportion of body weight, progressively decreases with advancing gestation (Fig. 8.2). Total body water represents 85 % of body weight in premature infants, 75 % in full-term neonates and 60 % in older children [1]. After birth, excess total body water is mobilized and excreted. Premature infants ( Fig. 8.2) mature through several distinct phases before achieving fluid homeostasis. The pre-diuretic phase, which occurs in the first 24-48 postnatal hours, is marked by urine outputs in the range of 0.5-1.5 ml/kg/h. During the subsequent diuretic phase, urine output increases to 3-5 ml/kg/h with a decrease in sodium excretion. As a result, there is 10-15 % weight loss during the first 5-7 postnatal days (with a weight loss of up to 20 % in infants <750 g). The precise mechanisms underlying the contraction of body fluids in the first few postnatal days are not clear but have been attributed, in part, to an atrial natriuretic peptide (ANP) diuresis secondary to increased pulmonary blood flow and stretch of left atrial receptors. Another contributing factor to this diuresis and weight loss during the first postnatal week (largely extracellular fluid loss) is tubular insensitivity to aldosterone [2, 3]. Postnatal Changes in Hypothalamic, Adrenal, and Renal Physiology Atrial Natriuretic PeptidesThe natriuretic peptides are involved in attenuating the reninangiotensin-aldosterone axis and sympathetic nervous system; suppression of vasopressin release; vasodilatation of the systemic, pulmonary, coronary, and renal circulations; and promotion of natriuresis and diuresis. When compared with older infants and children, neonates in the first few postnatal days have significantly greater circulating levels of natriuretic hormone, perhaps related to the acute increase in ventricular afterload that occurs after birth [3,4]. Plasma B-type natriuretic peptide (BNP) levels in neonates with respiratory disease, with persistent pulmonary hypertension of the newborn, are significantly greater than in those with normal right ventricular pressure. In children with known congenital heart disease, natriuretic hormone levels vary with the type and severity of the heart defect [5]. Hypothalamic-Pituitary-Adrenal AxisRemodelling of the adrenal glands after birth occurs via apoptosis of the fetal zone, by remodelling this zone and the development of other zones [6]. At birth, the concentration of free cortisol is only one-third that of maternal levels, with an inverse relationship between cortisol levels and gestational age. The size of the adrenal glands decreases by 25 % during the first 4 postnatal days. In full-term and late preterm neonates, low cord concentrations of ACTH, cortisol and free triiodothyronine are associated with lung fluid retention and transient tachypnea of the newborn (TTN) [7]. Transient insufficiency of the adrenal cortex has been reported in approximately 27 % of ELBW infants and critically ill neonates (defined as an inab...

show abstract

“…Regulation of volume and electrolyte homeostasis after cardiac surgery on cardiopulmonary bypass (CPB) in newborns and infants with congenital heart defects (CHD) is challenging [1, 2]. The use of CPB during open heart surgery is accompanied by an inflammatory response leading to capillary leak syndrome (CLS) [3–5].…”

Section: Introductionmentioning

confidence: 99%

First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery

et al. 2019

View full text Add to dashboard Cite

BackgroundPostoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality.MethodsTolvaptan (TLV, vasopressin type 2 receptor antagonist) was used as an additive diuretic in neonates and infants with CLS after cardiac surgery. Retrospective analysis of 25 patients with CLS including preoperative and postoperative parameters was performed. Multivariate regression analysis was performed to identify predictors for TLV response.ResultsMultivariate analysis identified urinary output during 24 h after TLV administration and mean blood pressure (BP) on day 2 of TLV treatment as predictors for TLV response (AUC = 0.956). Responder showed greater weight reduction (p < 0.0001), earlier weaning from ventilator during TLV (p = 0.0421) and shorter time in the ICU after TLV treatment (p = 0.0155). Serum sodium and serum osmolality increased significantly over time in all patients treated with TLV.ConclusionIn neonates and infants with diuretic-refractory CLS after cardiac surgery, additional aquaretic therapy with TLV showed an increase in urinary output and reduction in bodyweight in patients classified as TLV responder. Increase in urinary output and mean BP on day 2 of treatment were strong predictors for TLV response.Electronic supplementary materialThe online version of this article (10.1186/s12887-019-1418-6) contains supplementary material, which is available to authorized users.

show abstract

Is There a Benefit to Postoperative Fluid Restriction Following Infant Surgery?

Cited by 10 publications

References 15 publications

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

Perioperative Metabolic Care of the Term and Preterm Infant

First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery

Contact Info

Product

Resources

About