ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis.

Florence Porcheret, Jorge Lopez, Jesus López-Herce, Huw F Mayberry, Fortesa Mehmeti, Magdalena Mierzewska-Schmidt, Maria Miñambres Rodríguez, Claire Morice, John V Pappachan, Eva Kühlwein, Leonor Reis Boto, Luregn J Schlapbach, Hakan Tekguc, Konstantinos Tziouvas, Jean-Jacques Parienti, Isabelle Goyer, Frederic V Valla, David W Brossier, Martin C J Kneyber, Nyandat L Joram, Stavroula Ilia, Capucine Didier, Leonardo Costa, Fabrizio Chiusolo, Sophie Beldjilali, Fahad Alsohime, Luise V Marino, Sascha C A T Verbruggen, Shancy Rooze, Clémence Moullet, Corinne Jotterand Chaparro, Anais R Briant, Lyvonne N Tume

Journal: Intensive care medicine 2022;48(12):1691-1708

PMID: 36289081

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Abstract

PURPOSE

Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid.

METHODS

A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds.

RESULTS

56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations.

CONCLUSIONS

Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance.

Address: Pediatric Intensive Care, Medical School, Université Caen Normandie, CHU de Caen, Caen, France.; Pediatric Intensive Care Unit Alder Hey Children's Hospital, Faculty of Health, Social Care and Medicine, Edge Hill University, Liverpool, Ormskirk, UK.; Department of Biostatistics, CHU de Caen, 14000, Caen, France.; Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.; Bureau d'Echange des Savoirs pour des praTiques Exemplaires de Soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland.; Pediatric Intensive Care, HUDERF, Brussels, Belgium.; Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.; University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Pediatric Intensive Care, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.; Pediatric Intensive Care, Assistance Publique Hopitaux de Marseille, Marseille, France.; Pediatric Intensive Care, Bambino Gesù Children's Hospital, Rome, Italy.; Pediatric Intensive Care, S. Orsola-Malpighi University Hospital, Bologna, Italy.; Pediatric Intensive Care, Hospices Civils de Lyon, Lyon, France.; Pediatric Intensive Care, Medical School, University Hospital, University of Crete, Heraklion, Greece.; Moi Teaching and Referral Hospital, Eldoret, Kenya.; Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, Critical Care, Anaesthesiology, Peri-Operative and Emergency Medicine (CAPE), University of Groningen, Groningen, the Netherlands.; Department of Intensive Care and Neonatology, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.; Pediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain.; Pediatric Intensive Care, Alder Hey Childrens Hospital, Liverpool, UK.; Pediatric Intensive Care, University Hospital of Geneva, Geneva, Switzerland.; Department of Paediatric Anaesthesiology and Intensive Therapy, Medical University of Warsaw, Warsaw, Poland.; Pediatric Intensive Care, Virgen de la Arrixaca Hospital, Murcia, Spain.; Pediatric Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Department of Pediatric Nephrology, CHU de Nantes, Nantes, France.; Pediatric Intensive Care, Departament of Pediatrics, Faculdade de Medicina, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal.; Pediatric Intensive Care, Dr. Burhan Nalbantoglu State Hospital, Nicosia, North Cyprus, Cyprus.; Pediatric Intensive Care, Aglaia Kyriakou Children's Hospital, Athens, Greece.; Department of Biostatistics, CHU de Caen, Université Caen Normandie, INSERM U1311 DYNAMICURE, 14000, Caen, France.; Department of Pharmacy, CHU de Caen, Caen, France.; Pediatric Intensive Care, Hospices Civils de Lyon, Lyon, France. [email protected].; Service de Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69500, Bron, France. [email protected].

DOI: 10.1007/s00134-022-06882-z