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

Abstract

Fluid restriction is often employed immediately following cardiac surgery in children. The goal of this approach is to achieve an early negative fluid balance, which theoretically should lead to less interstitial edema and earlier extubation. The purpose of this study was to determine whether time to negative fluid balance in infants after undergoing systemic-to-pulmonary artery shunt palliation impacts duration of mechanical ventilation and hospital length of stay. This is a retrospective study of neonates who underwent a modified systemic-to-pulmonary artery shunt at a single institution. University hospital pediatric cardiac intensive care unit (CICU). Neonates who underwent a modified systemic-to-pulmonary artery shunt between January 1, 2009 and June 1, 2011. Information collected included time to negative fluid balance (in hours), CICU and hospital length of stay (in days), and the number of patients who had delayed sternal closure and/or underwent cardiopulmonary bypass. Data were available for 65 subjects. Median fluid administration in the 24 hours postoperatively was 43.9 cc/kg/day (interquartile range: 32.9-61.0). Mean time to negative fluid balance was 25.0 ± 12.8 hours. Time to negative fluid balance was not associated with time to extubation, CICU and hospital length of stay, or change in weight-for-age z-score at intensive care unit discharge. Time to negative fluid balance is not associated with duration of mechanical ventilation, CICU, and hospital length of stay in patients after undergoing systemic-to-pulmonary artery shunt palliation. The utility of a restricted fluid strategy immediately following infant heart surgery is questionable.