ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

Lyvonne N Tume, David Brossier, Frederic V. Valla, Corinne Jotterand Chaparro, Clémence Moullet, Claire Morice, Huw Mayberry, Luregn J. Schlapbach, Martin C.J. Kneyber, Shancy Rooze, Sascha C.A.T. Verbruggen, Luise Marino, Isabelle Goyer, John Pappachan, Anais Briant, Fahad Alsohime, Florence Porcheret, Hakan Tekguc, Nyandat Joram, Fabrizio ChiusoloLeonardo Costa, Eva Kühlwein, Jorge Lopez, Konstantinos Tziouvas, Fortesa Mehmeti, Sophie Beldjilali, Leonor Reis Boto, Magdalena Mierzewska-Schmidt, Jean-Jacques Parienti, Ilia Stavroula, Capucine Didier, Maria Rodriguez, Jesus Lopez-Herce

Research output: Contribution to journalArticle (journal)peer-review

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Purpose: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid. Methods: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds. Results: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. “Strong consensus” was reached for 11/16 (69%) and “consensus” for 5/16 (31%) of the recommendations. Conclusions: Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance.

Original languageEnglish
Pages (from-to)1691-1708
Number of pages18
JournalIntensive Care Medicine
Issue number12
Early online date26 Oct 2022
Publication statusPublished - 27 Oct 2022


  • Isotonic fluids
  • balanced fluids
  • hypnatremia
  • fluid balance
  • intensive care
  • acutely ill children

Research Institutes

  • Health Research Institute

Research Centres

  • Cardio-Respiratory Research Centre

Research Groups

  • Children and Young People Research Network


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