General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Surg. 2024 Nov;59(11):161660. doi: 10.1016/j.jpedsurg.2024.07.045. Epub 2024 Aug 7.
Postoperative maintenance fluids are traditionally provided via hypotonic dextrose containing fluids administered intravenously by continuous infusion. We hypothesized that scheduled weight-based boluses of balanced salt solution would be more physiologic, reduce fluid volumes, and improve patient comfort.
As part of an IRB-approved randomized controlled trial (Boluses of Ringer's in Surgical Kids, BRiSK), we randomized patients aged 1-21 years undergoing elective abdominal or thoracic surgery to post-operatively receive weight-based D0.45NS+20mEq/L KCl at a continuous rate or intermittent boluses of Lactated Ringer's solution until oral liquid toleration. Patients with nephropathy, diabetes, or receiving parenteral nutrition were excluded. We analyzed electrolytes, urine output, fluid volume, and adverse events.
We enrolled and randomized 60 patients: 29 to continuous fluids and 31 to bolus fluids. One patient from the bolus group dropped out. No patients crossed over due to difficulties with application of the bolus protocol. There were no baseline differences between groups with a mean age of 12.6 ± 1.4yr and weight of 50.9 ± 7.2 kg. There were no serious adverse events or electrolyte disturbances in either group. Patients in the bolus group received significantly less total fluid than those in the continuous group (0.43 mL/kg/h vs 1.1 mL/kg/h, p < 0.001) with no difference in urine output [1.4 ± 0.2 mL/kg/h vs 1.6 ± 0.3 mL/kg/h, p = 0.211]. There were two episodes of mild hypoglycemia in the bolus group compared to seven episodes of mild hyperglycemia in the continuous group.
Administration of post-operative intravenous fluids as boluses of balanced salt solution is feasible, safe, and results in significantly less fluid administered compared to a traditional continuous protocol.
II.
术后维持液传统上通过静脉内输注含低张葡萄糖的液体连续输注来提供。我们假设，按计划给予平衡盐溶液的体重剂量的推注将更符合生理，减少液体量，并提高患者舒适度。
作为一项经过机构审查委员会批准的随机对照试验（小儿外科中的林格氏液推注，BRiSK）的一部分，我们将年龄在 1-21 岁接受择期腹部或胸部手术的患者随机分为术后接受按体重给予的 0.45NS+20mEq/L KCl 持续输注或给予间断推注乳酸林格氏液，直至口服液体耐受。患有肾病、糖尿病或接受肠外营养的患者被排除在外。我们分析了电解质、尿量、液体量和不良事件。
我们共纳入并随机分配了 60 名患者：29 名接受连续输液，31 名接受推注输液。推注组中有 1 名患者退出。由于推注方案的实施困难，没有患者交叉到另一组。两组患者在平均年龄 12.6±1.4 岁和体重 50.9±7.2kg 方面没有基线差异。两组均无严重不良事件或电解质紊乱。推注组患者接受的总液体量明显少于连续组（0.43mL/kg/h 比 1.1mL/kg/h，p<0.001），尿量无差异[1.4±0.2mL/kg/h 比 1.6±0.3mL/kg/h，p=0.211]。推注组有两例轻度低血糖，而连续组有七例轻度高血糖。
给予术后静脉内液体作为平衡盐溶液的推注是可行的、安全的，与传统的连续方案相比，给予的液体量明显减少。
II 级。
