Restricted versus Usual/Liberal Maintenance Fluid Strategy in Mechanically Ventilated Children: An Open-Label Randomized Trial (ReLiSCh Trial).

IF 2.1 4区 医学 Q2 PEDIATRICS Indian Journal of Pediatrics Pub Date : 2025-01-01 Epub Date: 2023-10-18 DOI:10.1007/s12098-023-04867-4
Shubham Charaya, Suresh Kumar Angurana, Karthi Nallasamy, Muralidharan Jayashree
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Abstract

Objectives: To assess the impact of restricted vs. usual/liberal maintenance fluid strategy on fluid overload (FO) among mechanically ventilated children.

Methods: This open-label randomized controlled trial was conducted over a period of 1 y (October 2020-September 2021) in a Pediatric intensive care unit (PICU) in North India. Hemodynamically stable mechanically ventilated children were randomized to 40% (restricted group, n = 50) and 70-80% (usual/liberal group, n = 50) of maintenance fluids. The primary outcome was cumulative fluid overload percentage (FO%) on day 7. Secondary outcomes were FO% >10%; vasoactive inotropic score, sequential organ failure assessment score, pediatric logistic organ dysfunction score and oxygenation index from day 1-7; ventilation free days (VFDs) and PICU free days (PFDs) through day 28; and mortality.

Results: The restricted group had statistically non-significant trend towards lower cumulative FO% at day 7 [7.6 vs. 9.5, p = 0.40]; and proportion of children with FO% >10% (12% vs. 26%, p = 0.21) as compared to usual/liberal group. The increase in FO% from day 1-7 was significant in usual/liberal group as compared to restricted group (p <0.001 and p = 0.134, respectively). Restricted group received significantly lower amount of fluid in the first 5 d; had significantly higher VFDs (23 vs. 17 d, p = 0.008) and PFDs (19 vs. 15 d, p = 0.007); and trend towards lower mortality (8% vs. 16%, p = 0.21).

Conclusions: Restricted as compared to usual/liberal maintenance fluid strategy among mechanically ventilated children was associated with a trend towards lower rate and severity of FO and mortality; and significantly lower fluid volume received, and higher VFDs and PFDs.

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机械通气儿童的限制性与常规/自由性维持液策略:一项开放标签随机试验(ReLiSCh试验)。
目的:评估限制性与常规/自由性维持液策略对机械通气儿童液体超负荷(FO)的影响。方法:这项开放标签随机对照试验在印度北部的儿科重症监护室(PICU)进行,为期1年(2020年10月至2021年9月)。血液动力学稳定的机械通气儿童被随机分为40%(限制性组,n=50)和70-80%(常规/自由性组,n=50)的维持液。主要结果是第7天的累积液体过载百分比(FO%)。次要转归为FO%>10%;第1-7天的血管活性肌力评分、连续器官衰竭评估评分、儿童逻辑器官功能障碍评分和氧合指数;无通气天数(VFD)和无PICU天数(PFD)至第28天;以及死亡率。结果:在第7天,限制性组的累积FO%呈下降趋势,在统计学上无统计学意义[7.6对9.5,p=0.40];FO%>10%的儿童比例(12%对26%,p=0.021)。与限制组相比,常规/自由组从第1-7天起FO%的增加是显著的(p结论:在机械通气儿童中,与常规/自由维持液策略相比,限制维持液策略与FO的发生率和严重程度以及死亡率的降低趋势相关;接受的液体量显著降低,VFD和PFD更高。
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来源期刊
Indian Journal of Pediatrics
Indian Journal of Pediatrics 医学-小儿科
CiteScore
8.10
自引率
7.00%
发文量
394
审稿时长
3-6 weeks
期刊介绍: Indian Journal of Pediatrics (IJP), is an official publication of the Dr. K.C. Chaudhuri Foundation. The Journal, a peer-reviewed publication, is published twelve times a year on a monthly basis (January, February, March, April, May, June, July, August, September, October, November, December), and publishes clinical and basic research of all aspects of pediatrics, provided they have scientific merit and represent an important advance in knowledge. The Journal publishes original articles, review articles, case reports which provide new information, letters in relation to published articles, scientific research letters and picture of the month, announcements (meetings, courses, job advertisements); summary report of conferences and book reviews.
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