scholarly journals Intravenous Maintenance Fluid Therapy in the Pediatric Acute and Critical Care Setting: A European Practice Survey. Intravenous Maintenance Fluids in Pediatric Practice: A European Survey

2021 ◽  
Author(s):  
Claire Morice ◽  
Fahad Alsohime ◽  
Huw Mayberry ◽  
Lyvonne Tume ◽  
David William Brossier ◽  
...  
Keyword(s):  
Critical Care ◽  
Middle East ◽  
Critically Ill ◽  
Fluid Therapy ◽  
Survey Instrument ◽  
Critically Ill Children ◽  
Evidence Based ◽  
Maintenance Fluid ◽  
Middle East Countries ◽  
Maintenance Fluid Therapy

Abstract Background: The ideal fluid for intravenous maintenance fluid therapy (IV-MFT) in acutely and critically ill children is controversial and evidence based clinical practice guidelines are lacking. The current prescribing practices remains unknown.Aim: We aimed to describe the current practices and choice of pediatric acute care clinicians in prescribing IV-MFT in the context of acutely and critically ill children with regards to the amount, tonicity, composition, use of balanced fluid and prescribing strategies in various clinical contexts. Method: A cross-sectional electronic survey was emailed in April-May 2021 to pediatric critical care physicians across European and Middle East countries. The survey instrument was developed by an expert multi-professional panel within ESPNIC. The survey instrument included their practice of prescribing the IV-MFT: indication, amount, tonicity, use of balance solutions & composition of IV-MFT.Results: 154 respondents from 35 European and Middle East countries participated in this survey (response rate 64%). Respondents were staff physicians or nurse practitioners in charge of critically ill children. They all indicated that they routinely use a predefined formula to prescribe the amount of an IV-MFT. The use of balanced solution was preferred in case of altered serum Na and Cl levels or metabolic acidosis. 42% of responders (65/153) believed that balanced solutions should always be used. In terms of the indication and the composition of IV-MFT prescribed, responses were heterogenous among centers. 70% of the respondents (n=107) believed there was a gap between the current practice in their unit and what they considered ideal IV-MFT due to the lack of guidelines and inadequate training of health care professionals.Conclusion: Our study showed considerable variability in clinical prescribing practice of IV-MFT in PICUs across Europe and the middle east. There is an urgent need to develop evidence-based guidelines for IV-MFT prescription in acutely and critically ill children.

scholarly journals A Systematic Review and Pooled Prevalence of Paediatric Delirium in Critically Ill Children

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i31-i32
Author(s):  
D Semple ◽  
M M Howlett ◽  
J D Strawbridge ◽  
C V Breatnach ◽  
J C Hayden
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Critically Ill ◽  
Observational Studies ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Assessment Tools ◽  
Critically Ill Children ◽  
Confusion Assessment ◽  
Pooled Prevalence

Abstract Introduction Paediatric Delirium (PD) is a neuropsychiatric complication that occurs during the management of children in the critical care environment (Paediatric Intensive Care (PICU) and Neonatal Intensive Care (NICU). Delirium can be classified as hypoactive (decreased responsiveness and withdrawal), hyperactive (agitation and restlessness), and mixed (combined) (1). PD can be assessed using a number of assessment tools. PD has been historically underdiagnosed or misdiagnosed, having many overlapping symptoms with other syndrome such as pain and iatrogenic withdrawal syndrome (2). An appreciation of the extent of PD would help clinicians and policy makers drive interventions to improve recognition, prevention and management of PD in clinical practice. Aim To estimate the pooled prevalence of PD using validated assessment tools, and to identify risk factors including patient-related, critical-care related and pharmacological factors. Methods A systematic search of PubMed, EMBASE and CINAHL databases was undertaken. Eligible articles included observational studies or trials that estimated a prevalence of PD in a NICU/PICU population using a validated PD assessment tool. Validated tools are the paediatric Confusion Assessment Method-ICU (pCAM-ICU), the Cornell Assessment of Pediatric Delirium (CAPD), the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), pCAM-ICU severity scale (sspCAM-ICU), and the Sophia Observation Withdrawal Symptoms scale Paediatric Delirium scale (SOS-PD) (1). Only full text studies were included. No language restrictions were applied. Two reviewers independently screened records. Data was extracted using a pre-piloted form and independently verified by another reviewer. Quality was assessed using tools from the National Institutes of Health. A pooled prevalence was calculated from the studies that estimated PD prevalence using the most commonly applied tool, the CAPD (1). Results Data from 23 observational studies describing prevalence and risk factors for PD in critically ill children were included (Figure 1). Variability in study design and outcome reporting was found. Study quality was generally good. Using the validated tools prevalence ranged from 10–66% of patients. Hypoactive delirium was the most prevalent sub-class identified. Using the 13 studies that used the CAPD tool, a pooled prevalence of 35% (27%-43% 95%CI) was calculated. Younger ages, particularly less than two years old, sicker patients, particularly those undergoing mechanical and respiratory ventilatory support were more at risk for PD. Restraints, the number of sedative medications, including the cumulative use of benzodiazepines and opioids were identified as risk factors for the development of PD. PD was associated with longer durations of mechanical ventilation, longer stays and increased costs. Data on association with increased mortality risk is limited and conflicting. Conclusion PD affects one third of critical care admissions and is resource intense. Routine assessment in clinical practice may facilitate earlier detection and management strategies. Modifiable risk factors such as the class and number of sedative and analgesic medications used may contribute to the development of PD. Early mobility and lessening use of these medications present strategies to prevent PD occurrence. Longitudinal prospective multi-institutional studies to further investigate the presentations of the different delirium subtypes and modifiable risk factors that potentially contribute to the development of PD, are required. References 1. Semple D (2020) A systematic review and pooled prevalence of PD, including identification of the risk factors for the development of delirium in critically ill children. doi: 10.17605/OSF.IO/5KFZ8 2. Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU. Australian Critical Care. 2018;31(5):266–73

Comparison between Glucose Containing Solution D2.5% and Ringer Lactate as a Maintenance Fluid Management in Infants Undergoing Inguinal Hernia Repair

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Hosny Hasan Mohamed ◽  
Dalia Abd El Hameed Mohamad Nasr ◽  
Amin Mohamed El Ansary
Keyword(s):  
Body Weight ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Fluid Therapy ◽  
Fluid Management ◽  
The Other ◽  
Ringer Lactate ◽  
Maintenance Fluid ◽  
Maintenance Fluid Therapy

Abstract Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

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