Kinlin Laura M, Helmers Andrew J, Friedman Jeremy N, Beck Carolyn E
Department of Paediatrics, University of Toronto, Toronto, Ontario.
Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario.
Paediatr Child Health. 2019 Sep 19;25(8):518-524. doi: 10.1093/pch/pxz093. eCollection 2020 Dec.
Recent literature and guidelines support routine use of isotonic intravenous (IV) fluids for maintenance therapy in hospitalized infants and children. Current prescribing practices are unknown.
To elicit paediatric residents' choice of maintenance IV fluids, particularly with regard to tonicity, in a variety of clinical scenarios and patient ages. We hypothesized that residents would choose isotonic fluids in most cases, but there would be substantially more variability in fluid choice in the neonatal age group.
An Internet-based survey was e-mailed to trainees in the 17 paediatric residency programs across Canada, via the Canadian Paediatric Program Directors. The survey instrument included questions related to training, followed by a series of questions eliciting choice of IV fluid in a variety of clinical situations.
A total of 147 survey responses were submitted (22% response rate). Isotonic solutions were selected by >75% across all clinical scenarios involving infants and children. Very hypotonic fluids were seldom chosen. There was more variability in fluid choice in neonates, with evidence of significant differences in fluid tonicity based on senior versus junior resident status and geographical location.
Results imply a predominance of isotonic fluid use in infants and children, suggesting that clinical practice has changed in response to risk of hyponatremia with hypotonic IV fluids. As hypothesized, there was more variability with respect to choice of maintenance fluids in neonates. This likely reflects a paucity of guidance in an age group with unique physiologic factors affecting fluid and electrolyte status.
近期的文献和指南支持在住院婴幼儿和儿童的维持治疗中常规使用等渗静脉输液。目前的处方做法尚不清楚。
了解儿科住院医师在各种临床场景和患者年龄下对维持性静脉输液的选择，特别是关于张力方面。我们假设住院医师在大多数情况下会选择等渗液，但新生儿年龄组的输液选择差异会大得多。
通过加拿大儿科项目主任，将基于互联网的调查问卷通过电子邮件发送给加拿大17个儿科住院医师培训项目的学员。调查问卷包括与培训相关的问题，随后是一系列在各种临床情况下引出静脉输液选择的问题。
共提交了147份调查问卷回复（回复率为22%）。在所有涉及婴幼儿和儿童的临床场景中，超过75%的人选择了等渗溶液。很少有人选择极低渗液。新生儿的输液选择差异更大，有证据表明，根据住院医师的年资和地理位置，输液张力存在显著差异。
结果表明婴幼儿和儿童中使用等渗液占主导地位，这表明临床实践已因低渗静脉输液导致低钠血症的风险而发生改变。正如所假设的，新生儿维持液的选择差异更大。这可能反映出在这个受影响液体和电解质状态的独特生理因素的年龄组中缺乏指导。
