Intermittent boluses of balanced salt solution for post-operative intravenous hydration following elective major abdominal and thoracic surgery in children
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In brief
In brief
Retrospective study of 363 pediatric patients found intermittent bolus fluid administration reduced postoperative IV fluid volume by approximately 40-60% compared to continuous infusion, while maintaining adequate urine output and achieving faster return to regular diet and shorter hospital stays without increased complications.
Written by the GCMD Library team from the article.
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.