Pediatric Fluid Therapy Research Articles

Rules of Pediatric Fluid Therapy: Non-systematic review

Rules of Pediatric Fluid Therapy: Non-systematic review

Fluid choice during perioperative care in children: A survey of present-day proposing practice by anesthesiologists in a tertiary care hospital.

Background:Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists. Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital.Methods:After obtaining approval from the Departmental Research Review Committee, a survey form including questions was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed.Results:Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in this survey. Majority of anesthesiologist have used, 1/2 dextrose saline (52.7%) as fluid of choice in routine intraoperative maintenance, while Hartmann's solution (41.8%) and normal saline 0.9% (5.5%) were used for rest of the them. The Holliday-Segar method for maintenance fluid was mentioned by 92.7% of anesthesiologists.Conclusion:The use of hypotonic fluid in perioperative care in pediatric population is still being practiced despite the current guidelines. These results point to a considerable gap between the available evidence and practice.

The use of a noninvasive hemoglobin monitor for determining fluid distribution and elimination in pediatric patients undergoing minor surgery

In pediatric fluid therapy it would be preferable to describe distribution and elimination a fluid bolus based on repetitive hemoglobin (Hb) according to kinetic principles. Pulse CO-Oximetry is a recent advancement in patient monitoring that allows for the continuous noninvasive measurement of Hb (SpHb). The aim of this study was to describe the distribution and elimination of hydroxyethylstarch (HES) 130/0.4 in combination with crystalloids using a noninvasive Hb monitor in two cohorts of young children undergoing minor surgeries under general anesthesia. Two cohorts, 16 children aged 1-3years and 12 aged 4-6years, were investigated during anesthesia and minor surgical procedures. They were given a maintenance solution of lactated Ringer's and a fluid bolus of HES 130/0.4, 6mL/kg over a period of 20min. The whole procedure lasted 120min, and SpHb values were measured every 10min. The SpHb values were used to calculate plasma dilution, net volume, and mean residence time (MRT) of the infused fluid. A total of 377 measured SpHbs generated individual dilution plots that showed variability, particularly for the older cohort. Distribution and elimination rates of the infused fluid were calculated. Mean dilution plots were generated. There were no significant differences in dilution, net volume or MRT between groups. A non invasive Hb analyzer could be used to calculate fluid distribution. The variability in the data can probably be explained by reactions to anesthetic drugs, variability in measurement technique, variability in generating the complex capillary signals, and individual variability in baseline fluid status. The latter finding is important because this is a prerequisite for perioperative fluid planning for each individual.

Fluid and electrolyte therapy: a primer

The prescription of fluid therapy in pediatrics is a common clinical event. The foundations that underpin such therapy should be understood by all clinicians involved in the short-term care of children. This article describes some important basic principles of fluid management.

Hiponatremia postoperatoria en pacientes pediátricos

Fluid replacement therapy for pediatric patients in the past 50 years has meant the infusion of hypotonic solutions in amounts calculated using the Holliday-Segar formula. Recent studies have focused attention on the incidence of postoperative hyponatremia and associated morbidity and mortality rates, generating debate on the advisability of perioperative fluid therapy and calling into question both the effectiveness of this strategy and the quantities used. We report 3 cases of hyponatremic encephalopathy in children following different types of minor surgery. Free water excretion by the kidneys is known to be a conditioning factor in this therapy, yet the ideal way to provide pediatric fluid therapy is still hotly debated. The question cannot be resolved until large randomized clinical trials are carried out to compare the use of hypotonic and isotonic solutions. Some general recommendations can be offered, however, in the interest of lowering the incidence of electrolyte disturbances and diminishing their repercussions.

Perioperative fluid therapy in pediatrics

Perioperative fluid therapy should be considered as a medical prescription of which both the volume and the composition should be adapted to the patient status, the type of operation and the expected events in the postoperative period. Perioperative fluid therapy is aimed at providing maintenance fluid requirements, at correcting fluid deficit and at providing the volume of fluid needed to maintain adequate tissues perfusion. Recent literature is challenging the old concepts for maintenance fluid requirements described by Holliday and Segar in 1957(1), and the recommendations regarding both volume and content of perioperative solutions have been the subject of recent controversies. Fluid therapy in the neonatal period will not be considered in the present lecture.

“Maintenance” of a traditional stance

The past few years have been witness to a very disturbing series of articles, which have promoted a dangerous approach to pediatric fluid therapy based upon a fundamental misunderstanding of physiology. In brief, the articles in question advocated the use of isotonic solutions as the “maintenance” fluid in children. The rationale for this departure from decades of teaching has been a misinterpretation of some cases of severe hyponatremia developing in children receiving more dilute fluid. Specifically, most of these cases were in children with some degree of volume contraction, for whom “routine maintenance” fluids would not have been appropriate anyway. In this issue of The Journal, several distinguished experts in pediatric fluid therapy, including some who were involved in the very early development of our current concepts, review this controversy. This is a timely discussion of the topic. It should serve as a nice review of the basic physiology involved for the beginning student of pediatric fluid therapy. For the seasoned practitioner, it outlines in a compelling fashion why such a major change in our approach to maintenance fluid therapy is unwise and unwarranted. Acute hospital-induced hyponatremia in children: A physiologic approachThe Journal of PediatricsVol. 145Issue 5PreviewPhysicians giving children fluid therapy today seldom encounter overt dehydration or signs of shock that call for rapid and aggressive extracellular fluid (ECF) expansion. Physicians in the era when severe diarrheal dehydration was common first restored ECF with isotonic saline,a then planned maintenance and replacement therapies, using hypotonic saline. Today, physicians plan fluid therapy mostly for children with pneumonia, meningitis, other acute disorders, or for children scheduled for surgery. Full-Text PDF

Gamble and Darrow: pathfinders in body fluid physiology and fluid therapy for children, 1914-1964.

The development of body fluid physiology and fluid therapy in pediatrics has special importance in the history of medicine because this development introduced physiology into clinical practice. James Gamble and Dan Darrow were leaders in this enterprise. Gamble was part of the group John Howland attracted to Johns Hopkins to establish the first organized program for clinical investigators in pediatrics. This group initiated fluid therapy as effective treatment for diarrheal dehydration and, led by Gamble, developed the discipline of body fluid physiology. Gamble was the first to describe the nature of extracellular fluid (ECF) to clinicians, using the new terminology for characterizing electrolytes in solution. In doing so, he became the teacher of body fluid physiology to a generation of medical students. Inexplicably, in his later years he failed to adopt yet newer terminology defining cations, anions, and acid-base status. This failure compromised his legacy. Dan Darrow extended our understanding of how body fluids react to hyper- and hyponatremia and to potassium deficiency. He was the first to add potassium to parenteral fluid therapy. In doing so, he broadened clinicians' understanding of body fluids but changed the emphasis of fluid therapy from rapid ECF restoration to replacement of estimated deficits. Unfortunately, this change in concept, taught by his successors as deficit therapy, slowed the adoption of oral rehydration therapy for treating diarrheal dehydration. The lapses noted for each of these men, now seen in hindsight, pale in comparison to their contributions. Pediatrics, medicine, and surgery are all indebted to the research of each, which emphasized the value of basic physiology in clinical practice.

Principles of Pediatric Fluid Therapy

This short descriptive text discusses theories of fluid and acid-base homeostasis in basic terms for students, house staff, and clinicians. Each of the first three sections (Disorders of Hydration, Acid-Base Disorders, and Disorders of Potassium Metabolism) provides an ample background in physiological principles to make these topics understandable to the reader. For example, the section on hydration reviews water and electrolyte flux between the extracellular, intracellular, and interstitial compartments. This information is subsequently used to instruct the reader in assessing the severity, type (isotonic, hypertonic, or hypotonic), and management of dehydration in children. The chapter on acid-base disorders contains extensive descriptions of metabolic and respiratory acidosis and alkalosis, emphasizing the clinical situations that are associated with these disorders. The importance of renal and pulmonary compensatory and corrective mechanisms is discussed. The final two chapters are entitled Fluid Therapy and Parenteral Nutrition in the Pediatric Patient. The former chapter is comprehensive

Principles of Paediatric Fluid Therapy

Principles of Paediatric Fluid Therapy

Fluid Therapy in Children

Fluid therapy in children is based on biochemical and physiologic principles qualitatively and quantitiatively different from adults. The limitations imposed by body size requires greater precision in calculating fluid therapy for children. General methods of computing maintenance and deficit pediatric fluid therapy, and specific fluid therapy involved in treating acute problems associated with genitourinary disorders with be discussed.

Paediatric Fluid Therapy.

This book successfully combines basic physiology of water and electrolyte metabolism with applicable schedules of fluid therapy. It can be divided into three sections. The first 30 pages discuss principles of water, electrolyte and acid-base balance including basic differences in fluid compartment size, turnover and components in infants, children, and adults. The acid-base section includes a discussion of buffers, the use of the Astrup method, examples of classical problems and the usual indications and precautions observed when treating patients with bicarbonate or THAM buffer. Unfortunately not even simple renal physiology is included. Maintenance requirements including nutritionally complete parenteral feeding are summarized. The bulk of the text deals with treatment situations. Following definition of the problem, each section contains a brief discussion of pathophysiology, clinical and laboratory features, and treatment. Chapters that are especially informative are those considering iso-, hypo- and hypertonic dehydration and neonatal problems. Other subjects discussed

Practical Fluid Therapy in Pediatrics.

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Practical Fluid Therapy in Pediatrics

Practical Fluid Therapy in Pediatrics

Practical Fluid Therapy in Pediatrics

Medical Journal of AustraliaVolume 1, Issue 1 p. 14-14 Review Practical Fluid Therapy in Pediatrics First published: 01 January 1955 https://doi.org/10.5694/j.1326-5377.1955.tb37619.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Practical Fluid Therapy in Pediatrics, By Fontaine S. Hill, M.D.; 1954. Philadelphia and London: W. B. Saunders Company. Melbourne: W. Ramsay (Surgical), Limited. 9½″ × 6½″, pp. 296, with 20 illustrations. Price: 57s. Volume1, Issue1January 1955Pages 14-14 RelatedInformation

Practical Fluid Therapy in Pediatrics

Practical Fluid Therapy in Pediatrics