Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Eur J Pediatr. 2022 Aug;181(8):3163-3172. doi: 10.1007/s00431-022-04467-y. Epub 2022 May 3.
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.
静脉补液治疗（IV-MFT）在急性和危重病儿童中的理想液体存在争议，缺乏循证临床实践指南，目前的处方实践也不清楚。我们旨在描述在急性和危重病儿童的背景下，目前在 IV-MFT 处方方面的实践情况，包括输液量、张力、组成、平衡液的使用以及各种临床情况下的处方策略。2021 年 4 月至 5 月，我们向欧洲和中东国家的儿科重症监护医生发送了一份横断面电子 27 项调查。调查工具由欧洲儿科和新生儿重症监护学会（ESPNIC）的一个多专业专家小组开发。来自 35 个欧洲和中东国家的 154 名受访者参与了调查（回应率为 64%）。受访者是负责急性或危重病儿童的医生。所有受访者表示，他们通常使用预设公式来规定 IV-MFT 的用量，并认为液体平衡监测在急性和危重病儿童的管理中非常重要。如果血清钠和氯水平改变或代谢性酸中毒，他们会优先使用平衡溶液。近一半（42%，65/153）的受访者认为应始终使用平衡溶液。受访者认为在急性和危重病儿童中使用等渗 IV 溶液很重要。在规定 IV-MFT 的适应症和组成方面，各中心的回答存在差异。近 70%（107/154）的受访者认为，由于缺乏指南和医疗保健专业人员培训不足，目前的实践与他们认为的理想 IV-MFT 之间存在差距。结论：我们的研究表明，欧洲和中东地区急性儿科环境中 IV-MFT 的临床处方实践存在相当大的差异。迫切需要为急性和危重病儿童制定 IV-MFT 处方的循证指南。已知：• 维持性静脉补液治疗是许多住院儿童的标准治疗方法。• 维持性静脉补液治疗的处方通常基于霍利迪和西格尔的历史指南，即使这种做法与许多并发症有关。新内容：• 本研究提供了有关液体限制、液体张力和平衡方面的处方实践信息。• 本研究表明，欧洲和中东地区的静脉补液治疗在临床处方实践方面存在相当大的差异。
