Fluid challenge in children
Background: Fluid boluses are frequently utilized in children. Despite their frequency of use there is little objective data regarding the utility of fluid boluses, who they benefit the most, and what the effects are.
Aims: This study aimed to conduct pooled analyses to identify those who may be more likely to respond to fluid boluses as well as characterize clinical changes associated with fluid boluses.
Methods: A systematic review of the literature and meta-analysis was conducted to identify pediatric studies investigating the response to fluid boluses and clinical changes associated with fluid boluses.
Results: A total of 15 studies with 637 patients were included in the final analyses with a mean age of 650 days ± 821.01 (95% CI 586 to 714) and a mean weight of 10.5 kg ± 7.19 (95% CI 9.94 to 11.1). The mean bolus volume was 12.14 ml/kg ± 4.09 (95% CI 11.8 to 12.5) given over a mean of 19.55 minutes ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response : greater age [207.2 days (140.8 to 273.2)], lower cardiac index , and lower stroke volume . The following clinical parameters significantly changed after a fluid bolus: decreased HR , increased systolic blood pressure [7.7 mmHg (1.0 to 14.4)], increased mean arterial blood pressure [5.5 mmHg (3.1 to 7.8)], increased cardiac index [0.3 ml/min/m2 (0.1 to 0.6)], increased stroke volume [4.3 ml/m2 (3.5 to 5.2)], increased central venous pressure [2.2 mmHg (1.1 to 3.3)], and increased systemic vascular resistance [2.1 woods units/m2 (0.1 to 4.2)].
Conclusion: Fluid blouses increase arterial blood pressure or cardiac output by 10% in approximately 56% of pediatric patients. Fluid blouses lead to significant decrease in HR and significant increases in cardiac output, stroke volume, and systemic vascular resistance. Limited published data is available on the effects of fluid blouses on systemic oxygen delivery.
Loomba RS, Villarreal EG, Farias JS, Flores S, Bronicki RA. Fluid Bolus Administration in Children, Who Responds and How?: A Systematic Review and Meta-Analysis. Paediatr Anaesth. 2022 Jun 23. doi: 10.1111/pan.14512. Epub ahead of print. PMID: 35736026.