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dc.contributor.authorHassinger, Amanda B.
dc.contributor.authorValentine, Stacey L.
dc.date2022-08-11T08:10:13.000
dc.date.accessioned2022-08-23T16:59:44Z
dc.date.available2022-08-23T16:59:44Z
dc.date.issued2018-10-01
dc.date.submitted2018-08-13
dc.identifier.citation<p>Pediatr Crit Care Med. 2018 Oct;19(10):e551-e554. doi: 10.1097/PCC.0000000000001685. <a href="https://doi.org/10.1097/PCC.0000000000001685">Link to article on publisher's site</a></p>
dc.identifier.issn1529-7535 (Linking)
dc.identifier.doi10.1097/PCC.0000000000001685
dc.identifier.pmid30074980
dc.identifier.urihttp://hdl.handle.net/20.500.14038/43655
dc.description.abstractOBJECTIVES: Observational studies have shown that fluid overload is independently associated with increased morbidity in critically ill children, especially with respiratory pathology. It is unknown if recent evidence has influenced clinical practice. We sought to describe current IV fluid management in pediatric acute respiratory distress syndrome. DESIGN: Multinational, cross-sectional electronic survey. SETTING: Pediatric Acute Lung Injury and Sepsis Investigators Network. SUBJECTS: Pediatric intensivists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One-hundred fifty-four respondents (43% response rate) had a median 10 years of experience (Q1-Q3, 4-17.8), in ICUs with a median 24 beds (18-36), where 86% provided extracorporeal membrane oxygenation. For maintenance IV fluid, 96% used the "4-2-1" rule to determine rate, and 59% used dextrose with normal saline for content. For fluid resuscitation, 77% use normal saline in 10 milliliters per kilogram aliquots (42%) or as fluid challenges (37%). Less than 20% of respondents reported resuscitating with 20 mL/kg boluses. Documented intake over output is the favored vital sign to assess (75% vs 57%) and guide fluid management (97% vs 14%) over central venous pressure. The majority of respondents chose 10% fluid overload as the threshold to act in children with pediatric acute respiratory distress syndrome. The majority (77%) agreed that fluid accumulation contributes to worse outcomes in pediatric acute respiratory distress syndrome and should be treated. Ninety-one percent reported conservative fluid management in pediatric acute respiratory distress syndrome is likely to be beneficial or protective. CONCLUSIONS: Pediatric intensivists agree that acting on 10% fluid overload in children with pediatric acute respiratory distress syndrome is important. Decisions are being made largely using intake and output documentation, not central venous pressure. These findings are important for future pediatric acute respiratory distress syndrome interventional trials.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=30074980&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1097/PCC.0000000000001685
dc.subjectacute respiratory distress syndrome
dc.subjectfluid management
dc.subjectfluid overload
dc.subjectpediatric critical care
dc.subjectsurvey
dc.subjectCritical Care
dc.subjectFluids and Secretions
dc.subjectHealth Services Administration
dc.subjectPathological Conditions, Signs and Symptoms
dc.subjectPediatrics
dc.subjectRespiratory Tract Diseases
dc.titleSelf-Reported Management of IV Fluids and Fluid Accumulation in Children With Acute Respiratory Failure
dc.typeJournal Article
dc.source.journaltitlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
dc.source.volume19
dc.source.issue10
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/peds_pp/228
dc.identifier.contextkey12647333
html.description.abstract<p>OBJECTIVES: Observational studies have shown that fluid overload is independently associated with increased morbidity in critically ill children, especially with respiratory pathology. It is unknown if recent evidence has influenced clinical practice. We sought to describe current IV fluid management in pediatric acute respiratory distress syndrome.</p> <p>DESIGN: Multinational, cross-sectional electronic survey.</p> <p>SETTING: Pediatric Acute Lung Injury and Sepsis Investigators Network.</p> <p>SUBJECTS: Pediatric intensivists.</p> <p>INTERVENTIONS: None.</p> <p>MEASUREMENTS AND MAIN RESULTS: One-hundred fifty-four respondents (43% response rate) had a median 10 years of experience (Q1-Q3, 4-17.8), in ICUs with a median 24 beds (18-36), where 86% provided extracorporeal membrane oxygenation. For maintenance IV fluid, 96% used the "4-2-1" rule to determine rate, and 59% used dextrose with normal saline for content. For fluid resuscitation, 77% use normal saline in 10 milliliters per kilogram aliquots (42%) or as fluid challenges (37%). Less than 20% of respondents reported resuscitating with 20 mL/kg boluses. Documented intake over output is the favored vital sign to assess (75% vs 57%) and guide fluid management (97% vs 14%) over central venous pressure. The majority of respondents chose 10% fluid overload as the threshold to act in children with pediatric acute respiratory distress syndrome. The majority (77%) agreed that fluid accumulation contributes to worse outcomes in pediatric acute respiratory distress syndrome and should be treated. Ninety-one percent reported conservative fluid management in pediatric acute respiratory distress syndrome is likely to be beneficial or protective.</p> <p>CONCLUSIONS: Pediatric intensivists agree that acting on 10% fluid overload in children with pediatric acute respiratory distress syndrome is important. Decisions are being made largely using intake and output documentation, not central venous pressure. These findings are important for future pediatric acute respiratory distress syndrome interventional trials.</p>
dc.identifier.submissionpathpeds_pp/228
dc.contributor.departmentDepartment of Pediatrics, Division of Pediatric Critical Care
dc.source.pagese551-e554


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