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Fluid Management Practices After Surgery for Congenital Heart Disease

A Worldwide Survey*

Hanot, Jan, MD1; Dingankar, Adil R., DNB2; Sivarajan, V. Ben, MD, MS2,3; Sheppard, Cathy, RN2,3; Cave, Dominic, MD2,3; Garcia Guerra, Gonzalo, MD, MSc2,3

Pediatric Critical Care Medicine: April 2019 - Volume 20 - Issue 4 - p 357–364
doi: 10.1097/PCC.0000000000001818
Cardiac Intensive Care
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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.

1Department of Pediatrics, Pediatric Critical Care, MUMC+, Maastricht, The Netherlands.

2Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

3Pediatric Cardiac Intensive Care Unit, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada.

*See also p. 385.

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).

Dr. Dingankar is supported by a fellowship Grant from the Madden DeLuca Foundation. Dr. Cave received funding from Abbvie. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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

For information regarding this article, E-mail: jan.hanot@mumc.nl

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies