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- Michael J. Carter (United Kingdom)
- Eirik Nestaas (Norway)
FLUID MANAGEMENT IN THE CRITICALLY ILL NEONATE
- Silvia Iacobelli (France)
Abstract
Abstract Body
Fluid management in the critically ill neonate has a major impact on lung and renal function, and it may influence duration of illness and survival. With rare exceptions regarding antenatal conditions of dehydration, during the first week of life healthy neonates are expected to have a negative fluid balance of up to 5-10% of total body water. The goal for fluid and electrolyte management for these infants is to allow contraction of extracellular fluid content (ECF), but avoiding dehydration and while maintaining cardiovascular and renal function. It is not easy to define the optimal target of this negative balance for some sick, ELWB infants and near-term or term neonates with critical morbidities. Indeed, such patients admitted to NICUs may undergo an authentic phase of acute illness, where they may need fluid therapy for resuscitation or reestablishment of adequate intravascular volume and a variable amounts of “obligatory” fluid intake as part of their management (nutrition, drugs..). This makes that they are at risk of fluid accumulation, which is in turn associated with increased risk of serious morbidities and death. Fluid overload (FO) in the NICU is understudied, especially during the first week of life. Moreover, there is a lack of consensus on the best definition and on the gold-standard method to assess FO in critically ill neonates, as both these challenges can be confounded by the attended physiologic contraction of ECF content, and the attended postnatal growth after the transition phase, which are both measured as weight variations compared to birth.
FLUID MANAGEMENT IN THE CRITICALLY ILL CHILD IN THE PICU
- Joris Lemson (Netherlands)
Abstract
Abstract Body
Fluid administration remains an instresting topic in the care for critically ill children. Both hypovolemia and hypervolemia with edema formation can cause harm and may lead to a worse outcome. We will discuss the pediatric intensivists view on fluid managent at the bedside, what tools we have to guide fluid therapy and how effecient they are. Lastly we will try to answer the question what the best approach to fluid manament at the PICU might be.
OUTCOMES OF PEDIATRIC FLUID-REFRACTORY SEPTIC SHOCK ACCORDING TO DIFFERENT INOTROPIC OR VASOACTIVE STRATEGIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
- Lorenzo Zanetto (Italy)
Abstract
Background and Aims
The management of fluid-refractory septic shock (FRSS) requires inotropic or vasoactive agents for hemodynamic support. Currently, it is unclear which first-line inotrope or vasoactive drug is the best choice in children. Our aim was to determine the association between different inotropic or vasoactive strategies and specific outcomes in FRSS patients.
Methods
Systematic review and meta-analysis: five electronic databases have been searched for randomized controlled trials and observational cohort studies reporting outcomes of children with FRSS undergoing inotropic and/or vasoactive therapy. Only studies reporting separate data on outcomes according to different agents have been selected. Primary outcome was all-cause mortality. Data about drugs dosages, hospital and ICU length of stay, and adjunctive therapies have been collected and considered as secondary outcomes.
Results
Of the 20,375 identified articles, 12 met inclusion criteria, including a total of 974 children. Four studies included 630 patients receiving a single vasoactive agent. Of these, 339 received dopamine, 175 epinephrine, and 116 norepinephrine. The former group had a higher overall mortality (0-58%), compared to the epinephrine (3-48%) and norepinephrine (0-17%) ones. Three-hundred-forty-four patients received two vasoactive agents, with highest mortality among those receiving norepinephrine plus vasopressin (58%). Secondary outcomes were variably reported between studies. Steroids were the most frequent adjunctive therapies, used in 14% to 100% of patients.
Conclusions
Literature on the topic is highly heterogenous, with scarce data on outcomes of different inotropic and vasoactive agents. The final results of random-effect meta-analyses will allow to assess for differences in outcomes between agents used.