Fluid bolus administration in children, who responds and how? A systematic review and meta‐analysis
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...
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| Veröffentlicht in: | Pediatric anesthesia 2022-09, Vol.32 (9), p.993-999 |
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| creator | Loomba, Rohit S. Villarreal, Enrique G. Farias, Juan S. Flores, Saul Bronicki, Ronald A. |
| description | 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 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [−0.5 ml/min/m2 (−0.9 to −0.3)], and lower stroke volume [−5.1 ml/m2 (−7.9 to −2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [−5.6 bpm (−9.8 to −1.3)], 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 are available on the effects of fluid blouses on systemic oxygen delivery. |
| doi_str_mv | 10.1111/pan.14512 |
| format | Article |
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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 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [−0.5 ml/min/m2 (−0.9 to −0.3)], and lower stroke volume [−5.1 ml/m2 (−7.9 to −2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [−5.6 bpm (−9.8 to −1.3)], 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 are available on the effects of fluid blouses on systemic oxygen delivery.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.14512</identifier><language>eng</language><publisher>Glasgow: Wiley Subscription Services, Inc</publisher><subject>Blood pressure ; cardiac output ; fluid therapy ; Meta-analysis ; Pediatrics ; stroke volume ; Systematic review</subject><ispartof>Pediatric anesthesia, 2022-09, Vol.32 (9), p.993-999</ispartof><rights>2022 John Wiley & Sons Ltd.</rights><rights>Copyright © 2022 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3302-4335aadd57e508dd8a44d88ec8cf4536ed9f24b71ff163362c7e4644e0315d643</citedby><cites>FETCH-LOGICAL-c3302-4335aadd57e508dd8a44d88ec8cf4536ed9f24b71ff163362c7e4644e0315d643</cites><orcidid>0000-0002-9116-2835 ; 0000-0002-6274-5775 ; 0000-0001-9731-2876 ; 0000-0001-8993-5192</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.14512$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.14512$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids></links><search><creatorcontrib>Loomba, Rohit S.</creatorcontrib><creatorcontrib>Villarreal, Enrique G.</creatorcontrib><creatorcontrib>Farias, Juan S.</creatorcontrib><creatorcontrib>Flores, Saul</creatorcontrib><creatorcontrib>Bronicki, Ronald A.</creatorcontrib><title>Fluid bolus administration in children, who responds and how? A systematic review and meta‐analysis</title><title>Pediatric anesthesia</title><description>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 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [−0.5 ml/min/m2 (−0.9 to −0.3)], and lower stroke volume [−5.1 ml/m2 (−7.9 to −2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [−5.6 bpm (−9.8 to −1.3)], 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 are available on the effects of fluid blouses on systemic oxygen delivery.</description><subject>Blood pressure</subject><subject>cardiac output</subject><subject>fluid therapy</subject><subject>Meta-analysis</subject><subject>Pediatrics</subject><subject>stroke volume</subject><subject>Systematic review</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp10M1KAzEQB_BFFKzVg28Q8KLg2nzv9iSlWBWKetDzkm5macpusia7lt58BJ_RJzFtPQnOJQPzmyH8k-Sc4BsSa9Qqe0O4IPQgGRAucToWY3oYeyJEKiQXx8lJCCuMCaOSDhKY1b3RaOHqPiClG2NN6LzqjLPIWFQuTa092Gu0XjrkIbTO6gitRku3vkUTFDahgyYulHH8YWC9GzbQqe_PL2VVvQkmnCZHlaoDnP2-w-Rtdvc6fUjnz_eP08k8LRnDNOWMCaW0FhkInGudK851nkOZlxUXTIIeV5QvMlJVRDImaZkBl5wDZkRoydkwudzfbb177yF0RWNCCXWtLLg-FFTmmHKc8yzSiz905Xof_7tV45zFs5JGdbVXpXcheKiK1ptG-U1BcLENvIiBF7vAox3t7drUsPkfFi-Tp_3GDzVZgpw</recordid><startdate>202209</startdate><enddate>202209</enddate><creator>Loomba, Rohit S.</creator><creator>Villarreal, Enrique G.</creator><creator>Farias, Juan S.</creator><creator>Flores, Saul</creator><creator>Bronicki, Ronald A.</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9116-2835</orcidid><orcidid>https://orcid.org/0000-0002-6274-5775</orcidid><orcidid>https://orcid.org/0000-0001-9731-2876</orcidid><orcidid>https://orcid.org/0000-0001-8993-5192</orcidid></search><sort><creationdate>202209</creationdate><title>Fluid bolus administration in children, who responds and how? A systematic review and meta‐analysis</title><author>Loomba, Rohit S. ; Villarreal, Enrique G. ; Farias, Juan S. ; Flores, Saul ; Bronicki, Ronald A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3302-4335aadd57e508dd8a44d88ec8cf4536ed9f24b71ff163362c7e4644e0315d643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blood pressure</topic><topic>cardiac output</topic><topic>fluid therapy</topic><topic>Meta-analysis</topic><topic>Pediatrics</topic><topic>stroke volume</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Loomba, Rohit S.</creatorcontrib><creatorcontrib>Villarreal, Enrique G.</creatorcontrib><creatorcontrib>Farias, Juan S.</creatorcontrib><creatorcontrib>Flores, Saul</creatorcontrib><creatorcontrib>Bronicki, Ronald A.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Loomba, Rohit S.</au><au>Villarreal, Enrique G.</au><au>Farias, Juan S.</au><au>Flores, Saul</au><au>Bronicki, Ronald A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fluid bolus administration in children, who responds and how? A systematic review and meta‐analysis</atitle><jtitle>Pediatric anesthesia</jtitle><date>2022-09</date><risdate>2022</risdate><volume>32</volume><issue>9</issue><spage>993</spage><epage>999</epage><pages>993-999</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>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 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [−0.5 ml/min/m2 (−0.9 to −0.3)], and lower stroke volume [−5.1 ml/m2 (−7.9 to −2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [−5.6 bpm (−9.8 to −1.3)], 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 are available on the effects of fluid blouses on systemic oxygen delivery.</abstract><cop>Glasgow</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1111/pan.14512</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9116-2835</orcidid><orcidid>https://orcid.org/0000-0002-6274-5775</orcidid><orcidid>https://orcid.org/0000-0001-9731-2876</orcidid><orcidid>https://orcid.org/0000-0001-8993-5192</orcidid></addata></record> |
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| ispartof | Pediatric anesthesia, 2022-09, Vol.32 (9), p.993-999 |
| issn | 1155-5645 1460-9592 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2680240847 |
| source | Wiley-Blackwell Full Collection |
| subjects | Blood pressure cardiac output fluid therapy Meta-analysis Pediatrics stroke volume Systematic review |
| title | Fluid bolus administration in children, who responds and how? A systematic review and meta‐analysis |
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