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Albumin 5% Versus Crystalloids for Fluid Resuscitation in Children After Cardiac Surgery*

Dingankar, Adil R., DNB1; Cave, Dominic A., MD1–3; Anand, Vijay, MD1,2; Sivarajan, V. Ben, MD, MS1,2; Nahirniak, Susan, MD4; Sheppard, Cathy, RN2; Hanot, Jan, MD5; Garcia Guerra, Gonzalo, MD, MSc1,2

Pediatric Critical Care Medicine: September 2018 - Volume 19 - Issue 9 - p 846–853
doi: 10.1097/PCC.0000000000001657
Cardiac Intensive Care
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Objectives: To determine the clinical benefit of using colloids versus crystalloids for volume resuscitation in children admitted after cardiac surgery.

Design: Retrospective pre-/postintervention cohort study.

Setting: Stollery Children’s Hospital tertiary care pediatric cardiac ICU.

Patients: Children admitted to the pediatric cardiac ICU after cardiac surgery.

Interventions: Fluid resuscitation policy change in which crystalloids replaced albumin 5% as the primary fluid strategy for resuscitation after cardiac surgery.

Measurements and Main Results: Children who underwent cardiac surgery in the 6 months prior to the policy change (5% albumin group) were compared with children admitted during the 6 months after (crystalloid group). Demographic, perioperative, and outcome variables (fluid intake days 1–4 postoperative, vasoactive therapy, blood products, time to negative fluid balance, renal replacement therapies, mechanical ventilation, pediatric cardiac ICU, and length of stay) were collected. Data were analyzed using linear and logistic multivariate analysis. The study included 360 children. There was no association between fluid group and fluid intake (mL/kg) on day 1 postoperatively (coefficient, 2.84; 95% CI, 5.37–11.05; p = 0.497). However, crystalloid group was associated with significantly less fluid intake on day 2 (coefficient, –12.8; 95% CI, –22.0 to –3.65; p = 0.006), day 3 (coefficient, –14.9; 95% CI, –24.3 to –5.57; p = 0.002), and on the first 48 hours postoperative (coefficient, 10.1; 95% CI, –27.9 to –1.29; p = 0.032). Pediatric cardiac ICU stay (coefficient, –1.29; 95% CI, –2.50 to –0.08; p = 0.036) was shorter for the crystalloid group. There were no significant differences in the time to negative balance, need for renal replacement therapy, mechanical ventilation days, hospital stay, or pediatric cardiac ICU survival.

Conclusions: In our study, the use of albumin 5% for resuscitation after cardiac surgery was not associated with less fluid intake but rather the opposite. Albumin administration did not provide measured clinical benefit while exposing children to side effects and generating higher costs to the healthcare system.

1Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

2Pediatric Cardiac Intensive Care Unit, Stollery Children’s Hospital, Edmonton, AB, Canada.

3Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada.

4Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.

5Department of Pediatrics, Pediatric Critical Care, MUMC+, Maastricht, The Netherlands.

*See also p. 901.

This work was performed at the University of Alberta, Edmonton, AB, Canada.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the Madden Deluca Foundation. Dr. Dingankar is supported, in part, by a fellowship Grant from the Madden Deluca Foundation. Research in our pediatric cardiac ICU is generously supported, in part, by the Women and Children’s Health Research Institute.

Dr. Dingankar disclosed that his position is funded by the Madden Deluca Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: gonzalo.guerra@ahs.ca

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies