What do Clinicians Perceive as a Successful “Trial of Fluids”?

Hopper, Sandy M; McCarthy, Michelle; Tancharoen, Chasari; Lee, Katherine J.; Orsini, Francesca; Babl, Franz E

doi:10.1097/pec.0000000000000464

Cited by 2 publications

(6 citation statements)

References 8 publications

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“…1 Previous studies found that fluid intake greater than 9 mL/kg was adequate and less than 5 mL/kg was inadequate. 4 Although not superior to one another, children in both the INF and OA groups consumed a significantly larger amount of fluid in 1 hour. In addition, although not statistically different, both groups experienced a considerable reduction in pain.…”

Section: Discussionmentioning

confidence: 85%

“…Previous studies found that fluid intake greater than 9 mL/kg was adequate and less than 5 mL/kg was inadequate. 4 In addition, a review of expert opinion concluded that a difference of 4 mL/kg during oral rehydration therapy is clinically important. 1 Power analysis showed that 34 patients were required to achieve an 81% power to detect a difference of 4 mL/kg with an α value of 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…To our knowledge, there are no published data on the effectiveness of INF for reducing pain and improving oral fluid intake in painful infectious mouth conditions. Previous studies found that fluid intake greater than 9 mL/kg was adequate and less than 5 mL/kg was inadequate 4 . In addition, a review of expert opinion concluded that a difference of 4 mL/kg during oral rehydration therapy is clinically important 1 .…”

Section: Methodsmentioning

confidence: 99%

“…Further studies found that expert clinical opinions perceived fluid intake greater than 9 mL/kg as adequate and less than 5 mL/kg as inadequate and that a difference of 4 mL/kg during oral rehydration therapy is clinically important. 1,4 Determining a child's degree of dehydration can be a difficult task. The goal of the history and physical examination is to accurately classify the degree of dehydration as mild, moderate, or severe.…”

mentioning

confidence: 99%

“…Currently, the American Academy of Pediatrics recommends aggressive oral rehydration therapy over 4 hours and defines successful oral rehydration therapy as 0.4 mL/kg/min (24 mL/kg/h), which in the ED setting may be an unrealistic goal. Further studies found that expert clinical opinions perceived fluid intake greater than 9 mL/kg as adequate and less than 5 mL/kg as inadequate and that a difference of 4 mL/kg during oral rehydration therapy is clinically important 1,4 . Determining a child's degree of dehydration can be a difficult task.…”

mentioning

confidence: 99%

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Intranasal Fentanyl to Reduce Pain and Improve Oral Intake in the Management of Children With Painful Infectious Mouth Lesions

et al. 2022

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Objectives: Painful infectious mouth conditions such as herpangina, hand-foot-and-mouth disease, and herpetic gingivostomatitis can cause pain, dehydration, and hospitalization in young children. Treatment for these conditions is generally supportive and directed toward pain relief from ulcerative lesions, thus facilitating oral intake, and preventing dehydration. Attempts at oral therapy at home and in the emergency department are often refused and immediately spit back out. This study evaluated the efficacy of intranasal fentanyl (INF) compared with a commonly used oral (PO) acetaminophen/hydrocodone formulation for the treatment of children with painful infectious mouth conditions.Methods: This study was a prospective, nonblinded, randomized controlled noninferiority trial conducted in an academic tertiary care pediatric emergency department. The study enrolled children between the ages of 6 months and 18 years with painful infectious mouth lesions and poor oral intake. Patients were randomized to receive either INF (1.5 μg/kg, intervention) or PO acetaminophen/hydrocodone (0.15 mg/kg, control) based on the dose of hydrocodone. The primary outcome was volume of fluid intake per body weight (in milliliters per kilogram) 60 minutes after analgesic administration. Secondary outcomes included pain scores using a validated visual assessment scale (VAS; 1, no pain; 10, worst pain), hydration score (VAS; 1, well hydrated; 4, very dehydrated), admission rate and overall satisfaction score (VAS; 1, worst; 7, best). A priori power analysis indicated that 34 patients would achieve an 81% power with an α value of 0.05. Results:Of the 34 patients enrolled, 17 were randomized to INF and 17 to PO. The demographics between both groups were similar in age, weight, sex, and race. There were no significant differences in parental perception of pain ( P = 0.69) or hydration status ( P = 0.78). Oral fluid intake at 60 minutes was 20 mL/kg for INF versus 18 mL/kg for PO ( P = 0.53). Pain scores at 15 and 30 minutes were 1.7 versus 2.9 ( P = 0.09) and 0.6 versus 1.6 ( P = 0.59). Parental perceptions of pain and hydration status at 60 minutes were 2.2 versus 2.4 ( P = 0.77) and 1.7 versus 1.5 ( P = 0.37). Overall parental satisfaction was 6.4 for INF versus 6.5 for PO ( P = 0.71), and admission rate was 0 vs 12% ( P = 0.49). There were no adverse events such as respiratory, cardiac, or central nervous system depression in either group.Conclusions: Intranasal fentanyl seems to be a safe and effective alternative to acetaminophen with hydrocodone in reducing pain and improving hydration status in children with painful infectious mouth lesions and poor oral intake.

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Section: Discussionmentioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%