Skip to main content
SpringerLink
Log in

Intermittent boluses of balanced salt solution for post-operative intravenous hydration following elective major abdominal and thoracic surgery in children

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

Maintenance fluids following major operations in children are typically administered with a continuous rate. We hypothesized that administering fluids as intermittent boluses is more physiologic and could limit post-operative fluid volume, thereby avoiding harmful effects of excess fluid.

Methods

We retrospectively reviewed children aged 1–21 admitted after an elective major abdominal or thoracic operation from 2015 to 2021. We excluded non-elective operations and patients receiving peri-operative enteral or parenteral nutrition. We analyzed total fluid volume at 0–24, 24–48, 48–72, and 72–96 h, time to regular diet and discharge, and end-organ complications.

Results

We identified 363 patients, of which 108 received intermittent boluses and 255 continuous fluids. Bolus group patients received significantly less fluid up to 72 h post-operatively with average rates of 0.49 mL/kg/h vs 0.86 mL/kg/h at 0–24 h (p << 0.01), 0.57 mL/kg/h vs 1.46 mL/kg/h at 24–48 h (p << 0.01), and 0.50 vs 0.92 mL/kg/h at 48–72 h (p << 0.01). Additionally, the bolus group maintained adequate urine output, tolerated a regular diet sooner (2.08 days vs 2.51 days; p = 0.0023) and averaged a shorter hospital stay (3.12 vs 4.14 days; p = 0.004). There was no difference in adverse effects between the two groups.

Conclusion

Utilizing intermittent boluses reduces the volume of maintenance fluids administered and may lead to a faster time to regular diet and discharge.

Level of evidence

IV.

Type of study

Retrospective review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Holliday MA, Segar WE (1957) The maintenance need for water in parenteral fluid therapy. Pediatrics 19:823–832

    Article  CAS  Google Scholar 

  2. Way C, Dhamrait R, Wade A et al (2006) Perioperative fluid therapy in children: a survey of current prescribing practice. Br J Anaesth 97:371–379

    Article  CAS  Google Scholar 

  3. Alves JT, Troster EJ, Oliveira CA (2011) Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children. J Pediatr 87:478–486

    Article  Google Scholar 

  4. Sümpelmann R, Becke K, Zander R et al (2019) Perioperative fluid management in children: can we sum it all up now? Curr Opin Anaesthesiol 32:384–391

    Article  Google Scholar 

  5. Sümpelmann R, Becke K, Crean P et al (2011) European consensus statement for intraoperative fluid therapy in children. Eur J Anaesthesiol 28:637–639

    Article  Google Scholar 

  6. Yunos NM, Bellomo R, Hegarty C et al (2012) Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 308:1566–1572

    Article  CAS  Google Scholar 

  7. Myburgh JA, Mythen MG (2013) Resuscitation fluids. N Engl J Med 369:1243–1251

    Article  CAS  Google Scholar 

  8. Malbrain M, Langer T, Annane D et al (2020) Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Ann Intensive Care 10:64

    Article  Google Scholar 

  9. Sumpelmann R, Becke K, Brenner S et al (2017) Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Paediatr Anaesth 27:10–18

    Article  Google Scholar 

  10. Arieff AI (1998) Postoperative hyponatraemic encephalopathy following elective surgery in children. Paediatr Anaesth 8:1–4

    Article  CAS  Google Scholar 

  11. Ayus JC, Achinger SG, Arieff A (2008) Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Renal Physiol 295:619–624

    Article  Google Scholar 

  12. Nishina K, Mikawa K, Maekawa N et al (1995) Effects of exogenous intravenous glucose on plasma glucose and lipid homeostasis in anesthetized infants. Anesthesiology 83:258–263

    Article  CAS  Google Scholar 

  13. Self WH, Semler MW, Wanderer JP et al (2018) Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 378:819–828

    Article  Google Scholar 

  14. Berleur MP, Dahan A, Murat I et al (2003) Perioperative infusions in paediatric patients: rationale for using Ringer-lactate solution with low dextrose concentration. J Clin Pharm Ther 28:31–40

    Article  CAS  Google Scholar 

  15. Sumpelmann R, Mader T, Eich C et al (2010) A novel isotonic-balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational postauthorization safety study (PASS). Paediatr Anaesth 20:977–981

    Article  Google Scholar 

  16. Shan SK, Uray KS, Stewart RH et al (2011) Resuscitation-induced intestinal edema and related dysfunction: state of the science. J Surg Res 166:120–130

    Article  Google Scholar 

  17. Radhakrishnan RS, Xue H, Weisbrodt N et al (2005) Resuscitation-induced intestinal edema decreases stiffness and residual stress of the intestine. Shock 24:165–170

    Article  Google Scholar 

  18. Cordemans C, De Laet I, Regenmortel NV et al (2012) Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care 5:2–12

    Google Scholar 

  19. Boyd JH, Forbes J, Nakada TA et al (2011) Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 39:259–265

    Article  Google Scholar 

  20. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575

    Article  Google Scholar 

  21. Saringcarinkul A, Kotrawera K (2009) Plasma glucose level in elective surgical patients administered with 5% dextrose in 0.45% NaCl in comparison with those receiving lactated ringer’s solution. J Med Assoc Thai 92:1178–1183

    PubMed  Google Scholar 

  22. Rajan S, Barua K, Tosh P et al (2020) Is intraoperative supplementation of dextrose essential for infants undergoing facial cleft surgeries? J Anaesthesiol Clin Pharmacol 36:162–165

    Article  CAS  Google Scholar 

  23. Adenekan AT (2014) Perioperative blood glucose in a paediatric daycase facility: effects of fasting and maintenance fluid. Afr J Paediatr Surg 11:317–322

    Article  Google Scholar 

Download references

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. General, Thoracic, and Fetal Surgery, Department of Surgery, Wood 5, Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, 19104, USA

    William R. Johnston, Rosa Hwang & Peter Mattei

  2. Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    William R. Johnston

Authors
  1. William R. Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosa Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Mattei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Mattei.

Ethics declarations

Conflict of interest

Statement of competing interests: the authors have no competing interests to declare. No financial support has been provided for this research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johnston, W.R., Hwang, R. & Mattei, P. Intermittent boluses of balanced salt solution for post-operative intravenous hydration following elective major abdominal and thoracic surgery in children. Pediatr Surg Int 38, 573–579 (2022). https://doi.org/10.1007/s00383-022-05081-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-022-05081-7

Keywords

Search

Navigation