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Meta-Analysis
. 2022 Dec;48(12):1691-1708.
doi: 10.1007/s00134-022-06882-z. Epub 2022 Oct 26.

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

David W Brossier  1 , Lyvonne N Tume  2 , Anais R Briant  3 , Corinne Jotterand Chaparro  4   5 , Clémence Moullet  4 , Shancy Rooze  6 , Sascha C A T Verbruggen  7 , Luise V Marino  8 , Fahad Alsohime  9 , Sophie Beldjilali  10 , Fabrizio Chiusolo  11 , Leonardo Costa  12 , Capucine Didier  13 , Stavroula Ilia  14 , Nyandat L Joram  15 , Martin C J Kneyber  16 , Eva Kühlwein  17 , Jorge Lopez  18 , Jesus López-Herce  18 , Huw F Mayberry  19 , Fortesa Mehmeti  20 , Magdalena Mierzewska-Schmidt  21 , Maria Miñambres Rodríguez  22 , Claire Morice  20 , John V Pappachan  23 , Florence Porcheret  24 , Leonor Reis Boto  25 , Luregn J Schlapbach  17 , Hakan Tekguc  26 , Konstantinos Tziouvas  27 , Jean-Jacques Parienti  28 , Isabelle Goyer  29 , Frederic V Valla  30   31 ; Metabolism Endocrinology and Nutrition section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC)
Affiliations
Meta-Analysis

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

David W Brossier et al. Intensive Care Med. 2022 Dec.

Erratum in

  • Correction: ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children-a systematic review and meta-analysis.
    Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, Verbruggen SCAT, Marino LV, Alsohime F, Beldjilali S, Chiusolo F, Costa L, Didier C, Ilia S, Joram NL, Kneyber MCJ, Kühlwein E, Lopez J, López-Herce J, Mayberry HF, Mehmeti F, Mierzewska-Schmidt M, Miñambres Rodríguez M, Morice C, Pappachan JV, Porcheret F, Reis Boto L, Schlapbach LJ, Tekguc H, Tziouvas K, Parienti JJ, Goyer I, Valla FV; Metabolism Endocrinology and Nutrition section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Brossier DW, et al. Intensive Care Med. 2023 Jan;49(1):128-129. doi: 10.1007/s00134-022-06933-5. Intensive Care Med. 2023. PMID: 36434102 Free PMC article. No abstract available.
  • Correction: ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis.
    Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, Verbruggen SCAT, Marino LV, Alsohime F, Beldjilali S, Chiusolo F, Costa L, Didier C, Ilia S, Joram NL, Kneyber MCJ, Kühlwein E, Lopez J, López-Herce J, Mayberry HF, Mehmeti F, Mierzewska-Schmidt M, Miñambres Rodríguez M, Morice C, Pappachan JV, Porcheret F, Reis Boto L, Schlapbach LJ, Tekguc H, Tziouvas K, Parienti JJ, Goyer I, Valla FV; Metabolism Endocrinology and Nutrition section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Brossier DW, et al. Intensive Care Med. 2023 Sep;49(9):1151-1153. doi: 10.1007/s00134-023-07119-3. Intensive Care Med. 2023. PMID: 37488304 Free PMC article. No abstract available.

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.

Keywords: Acutely ill children; Balanced fluids; Fluid balance; Hyponatremia; Intensive care; Isotonic fluids.

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Conflict of interest statement

LRB and FVV declare consultant fees received from Baxter. IG received consultant fees from BBraun medical. Other authors declare no conflicting interest.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of literature search and study screening
Fig. 2
Fig. 2
Meta-analysis of studies comparing the impact on length of stay of intravenous versus enteral hydration
Fig. 3
Fig. 3
Meta-analysis of studies comparing the impact on hyponatremia occurrence of isotonic versus hypotonic solutions
Fig. 4
Fig. 4
Meta-analysis of studies comparing the impact on acute or critical care stay of balanced versus non-balanced solutions
Fig. 5
Fig. 5
Meta-analysis of studies comparing the impact on natremia of a restrictive versus a non-restrictive fluid strategy
Fig. 6
Fig. 6
Short answers to PICO questions
See this image and copyright information in PMC

References

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