TY - JOUR
T1 - Intravenous maintenance fluid therapy practice in the pediatric acute and critical care settings
T2 - a European and Middle Eastern survey
AU - Morice, Claire
AU - Alsohime, Fahad
AU - Mayberry, Huw
AU - Tume, Lyvonne N.
AU - Brossier, David
AU - Valla, Frederic V.
AU - Didier, Capucine
AU - Moullet, Clémence
AU - Jotterand Chaparro, Corinne
AU - Kühlwein, Eva
AU - Chiuslo, Fabrizio
AU - Porcheret, Florence
AU - Mehmeti, Fortesa
AU - Tekguc, Hakan
AU - Stavroula, Ilia
AU - Goyer, Isabelle
AU - Lopez-Herce, Jesus
AU - Pappachan, John
AU - Lopez, Jorge
AU - Tziouvas, Konstantinos
AU - Costa, Leonardo
AU - Boto, Leonor Reis
AU - Marino, Luise
AU - Schapbach, Luregn
AU - Mierzewska-Schmidt, Magdalena
AU - Minambres, Maria
AU - Kneyber, Martin
AU - Fae, Monica
AU - Joram, Nyandat
AU - Kenderessy, Peter
AU - Verbruggen, Sascha
AU - Rooze, Shancy
AU - Beldjilali, Sophie
AU - for the ESPNICIVMFT group
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/5/3
Y1 - 2022/5/3
N2 - 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. We aimed to describe the current practices in prescribing IV-MFT in the context of acute and critically ill children with regard to the amount, tonicity, composition, use of balanced fluids, and prescribing strategies in various clinical contexts. 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). A total of 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 were 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 healthcare professionals. Conclusions: 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.What is Known:• The administration of maintenance intravenous fluid therapy is a standard of care for a lot of hospitalized children• Maintenance intravenous fluid therapy prescriptions are often based on Holliday and Segar’s historical guidelines even if this practice has been associated with several complications.What is New:• This study provided information on the prescribing practice regarding fluid restriction, fluid tonicity, and balance.• This study showed considerable variability in clinical prescribing practice of intravenous maintenance fluid therapy across Europe and the Middle East.
AB - 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. We aimed to describe the current practices in prescribing IV-MFT in the context of acute and critically ill children with regard to the amount, tonicity, composition, use of balanced fluids, and prescribing strategies in various clinical contexts. 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). A total of 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 were 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 healthcare professionals. Conclusions: 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.What is Known:• The administration of maintenance intravenous fluid therapy is a standard of care for a lot of hospitalized children• Maintenance intravenous fluid therapy prescriptions are often based on Holliday and Segar’s historical guidelines even if this practice has been associated with several complications.What is New:• This study provided information on the prescribing practice regarding fluid restriction, fluid tonicity, and balance.• This study showed considerable variability in clinical prescribing practice of intravenous maintenance fluid therapy across Europe and the Middle East.
KW - Adolescent
KW - Balanced solutions
KW - Child
KW - In-hospital
KW - Intravenous fluids
KW - Neonate
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U2 - 10.1007/s00431-022-04467-y
DO - 10.1007/s00431-022-04467-y
M3 - Article (journal)
C2 - 35503578
AN - SCOPUS:85129444339
SN - 0340-6199
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
ER -