Intravenous maintenance fluid therapy practice in the pediatric acute and critical care settings : a European & Middle Eastern survey

Morice, C; Alsohime, F; Mayberry, H; Tume, LN; Brossier, D; Valla, F

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 and current prescribing practices remain unknown.
Aim: We aimed to describe the current practices in prescribing IV-MFT in the context of acute and critically ill children with regards to the amount, tonicity, composition, use of balanced fluids and prescribing strategies in various clinical contexts.
Method: A cross-sectional electronic 27 item 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 the European Society of Pediatric and Neonatal Intensive Care (ESPNIC).
Results: 154 respondents from 35 European and Middle East countries participated (response rate 64%). Respondents were physicians in charge of acute or critically ill children. All respondents indicated they routinely use a predefined formula to prescribe the amount of IV-MFT and considered fluid balance monitoring very important in the management of acute and critically ill children. The use of balanced solution was preferred if there was altered serum sodium and chloride levels or metabolic acidosis. Just under half (42%, 65/153) of respondents believed balanced solutions should always be used. Respondents considered the use of isotonic IV solutions as important for acute and critically ill children. In terms of the indication and the composition of IV-MFT prescribed, responses were heterogeneous among centers. Almost 70% (107/154) respondents believed there was a gap between current practice and what they considered ideal IV-MFT due to a lack of guidelines and inadequate training of health care professionals.
Conclusion: Our study showed considerable variability in clinical prescribing practice of IV-MFT in acute pediatric settings across Europe and the Middle East. There is an urgent need to develop evidence-based guidelines for IV-MFT prescription in acute and critically ill children.

• Journal Article Type: Article
• Acceptance Date: Mar 22, 2022
• Publication Date: May 3, 2022
• Deposit Date: Mar 22, 2022
• Publicly Available Date: May 3, 2023
• Journal: European Journal of Pediatrics
• Print ISSN: 0340-6199
• Electronic ISSN: 1432-1076
• Publisher: Springer Verlag
• Volume: 181
• Pages: 3163-3172
• DOI: https://doi.org/10.1007/s00431-022-04467-y
• Publisher URL: https://doi.org/10.1007/s00431-022-04467-y
• Additional Information: Additional Information : "This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s00431-022-04467-y."