From the Faculty of Medicine, University of Bern.
Department of Pediatric Surgery.
Pediatr Emerg Care. 2021 Dec 1;37(12):e812-e816. doi: 10.1097/PEC.0000000000001813.
The ideal asanguineous intravenous fluid for volume resuscitation in children is controversially debated and clinical practice guidelines are scarce. Administration of large amounts of normal saline has been associated with complications including hyperchloremic acidosis, dysnatremia, neurologic damage, and fatality.
We examined the current practice of intravenous fluid and blood product administration in acutely ill and injured children among pediatric acute care physicians in Switzerland.
For this descriptive, cross-sectional study, pediatric emergency departments, pediatric and neonatal intensive care units were surveyed by means of an online questionnaire.
Sixty of 66 departments and 47 of 87 participants returned the survey. Normal saline (NS) was most commonly administered (n = 42/46, 91.3%) and twice as many times as balanced electrolyte solutions (n = 20/46, 43.5%). The mean fluid volumes ranged from 7.9 to 19.1 mL/kg. Hypertonic saline/NS were selected most often for shock with severe head injury. Half of participants administered colloids (48.9%). Packed red blood cells (97.7%) and fresh frozen plasma (88.4%) were most frequently given blood products.
There is a distinct practice variation in intravenous fluid and blood product administration in children in Switzerland. Although NS is most frequently given, we observed a trend toward the use of balanced electrolyte solutions. Prospective studies are warranted to compare NS with balanced electrolyte solution (BES) in the pediatric acute care setting. We suggest that pediatric fluid administration guidelines and mass transfusion protocols are implemented to standardize this frequent intervention and minimize complications.
在儿童容量复苏中，理想的无血静脉输液存在争议，临床实践指南也很少。大量输注生理盐水与包括高氯性酸中毒、电解质紊乱、神经损伤和死亡在内的并发症有关。
我们调查了瑞士儿科急救医生在急性患病和受伤儿童中静脉输液和血制品使用的现状。
这项描述性的横断面研究通过在线问卷调查了儿科急诊科、儿科和新生儿重症监护病房。
66 个科室中有 60 个，87 个参与者中有 47 个回复了调查。生理盐水（NS）的使用率最高（n = 42/46，91.3%），是平衡电解质溶液的两倍（n = 20/46，43.5%）。平均液体量为 7.9 至 19.1 mL/kg。高渗盐水/NS 主要用于伴有严重头部损伤的休克。一半的参与者输注胶体（48.9%）。红细胞悬液（97.7%）和新鲜冰冻血浆（88.4%）是最常输注的血制品。
瑞士儿童静脉输液和血制品使用的实践存在明显差异。尽管 NS 的使用率最高，但我们观察到使用平衡电解质溶液的趋势。需要前瞻性研究来比较 NS 与平衡电解质溶液（BES）在儿科急救环境中的应用。我们建议实施儿科液体管理指南和大量输血方案，以规范这一常见干预措施并减少并发症。
