Clinical Practice Guideline: Maintenance Intravenous Fluids in Children
Clinical Practice Guideline: Maintenance Intravenous Fluids in Children
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DOI：
10.1542/peds.2018-3083
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发表时间：
2018-12-01
期刊：
影响因子：
8
通讯作者：
Moritz, Michael L.
中科院分区：
文献类型：
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作者：
Feld, Leonard G.;Neuspiel, Daniel R.;Moritz, Michael L.
维持性静脉输液（IVF）用于为急性疾病的儿童提供关键的支持性护理。如果由于胃肠道疾病、呼吸系统损害、神经功能障碍、围手术期状态或因急性或慢性疾病而濒临死亡等原因无法通过肠内给药提供足够的液体，则需要IVF。尽管维持性IVF的使用很普遍，但液体处方实践存在很高的变异性，并且缺乏液体成分管理和电解质监测的指南。低渗IVF的管理已成为儿科的标准。人们担心这种方法会导致低钠血症的高发生率，而等渗IVF可以预防低钠血症的发生。我们在本指南中的目标是提供一种基于证据的方法，用于选择大多数需要维持IVF的28天至18岁患者的维持IVF的张力。本指南适用于手术（术后）和医疗急救环境中的儿童，包括重症监护和普通住院病房。排除患有神经外科疾病、先天性或获得性心脏病、肝病、癌症、肾功能不全、尿崩症、大量水样腹泻或严重烧伤的患者;年龄小于28天或在NICU的新生儿;以及年龄大于18岁的青少年。我们专门讨论了儿童维持性IVF的张力。小组委员会的关键行动声明如下：1A：美国儿科学会建议，需要维持性IVF的28天至18岁的患者应接受含有适当氯化钾和葡萄糖的等渗溶液，因为它们可显著降低发生低钠血症的风险（证据质量：A;建议强度：强）
Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring. The administration of hypotonic IVFs has been the standard in pediatrics. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns; neonates who are younger than 28 days old or in the NICU; and adolescents older than 18 years old are excluded. We specifically address the tonicity of maintenance IVFs in children.The Key Action Statement of the subcommittee is as follows:1A: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A; recommendation strength: strong)