ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis

PURPOSE Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid. METHODS A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds. RESULTS 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations. CONCLUSIONS Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance

Monitoring mechanical stimulation for optimal tendon tissue engineering: a mechanical and biological multiscale study

International audienc

Monitoring mechanical stimulation for optimal tendon tissue engineering: a mechanical and biological multiscale study

International audienc

ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis

PURPOSE: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid. METHODS: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds. RESULTS: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations. CONCLUSIONS: Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance

Correction to:Intravenous maintenance fluid therapy practice in the pediatric acute and critical care settings: a European and Middle Eastern survey (European Journal of Pediatrics, (2022), 181, 8, (3163-3172), 10.1007/s00431-022-04467-y)

In the original published version of the above article, the following names under "the ESPNICIVMFT group" were presented incorrectly and are now corrected as shown below: Luregn J Schlapbach Fabrizio Chiusolo and is affiliated to "Pediatric Intensive Care, Bambino Gesù Children’s Hospital, Rome, Italy" Stavroula Ilia The original article has been corrected.</p

ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

Purpose: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid. Methods: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds. Results: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. “Strong consensus” was reached for 11/16 (69%) and “consensus” for 5/16 (31%) of the recommendations. Conclusions: Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance

ESPNIC clinical practice guidelines ::intravenous maintenance fluid therapy in acute and critically ill children : a systematic review and meta-analysis

Purpose: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid. Methods: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds. Results: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. “Strong consensus” was reached for 11/16 (69%) and “consensus” for 5/16 (31%) of the recommendations

Correction:ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis (Intensive Care Medicine, (2022), 48, 12, (1691-1708), 10.1007/s00134-022-06882-z)

Figure 3 (Meta‑analysis of studies comparing the impact on hyponatremia occurrence of isotonic versus hypotonic solutions) published in the original version of the manuscript is incorrect [1]. A new version of Fig. 3 is provided in this erratum. (Figure presented.) Meta-analysis of studies comparing the impact on hyponatremia occurrence of isotonic versus hypotonic solutions The error arose from the reversal of the “experimental” and “control” groups during data extraction. In fact, in the included studies, the experimental and control groups corresponded to the “isotonic” and “hypotonic” groups respectively, in most studies, but not all [2, 3]. To ensure optimal homogeneity in outcome definition we have revised where possible the threshold of hyponatremia at 135 mmol/L rather than 130 mmol/L in the few studies that used a 130 mmol/L hyponatremia as the primary outcome but also provided figures for 135 mmol/L [4–6]. Finally, in the study with 3 arms, we revised the experimental and control groups to ensure better consistency in interpretation within the studies [7]. The new effect size in Fig. 3 is OR = 0.31, 95%CI [0.23; 0.42], I2 = 36%, p-value &lt; 0.00001. The heterogeneity between studies is now low. The authors consider it important to publish this erratum to comply with good research practice. Importantly, the updated results do not alter, but rather strengthen the level of evidence for the PiCO2 recommendation: “in acutely and critically ill children, isotonic maintenance fluid should be used to reduce the risk of hyponatremia”; level of evidence A. The authors apologize for this error.</p