• Adil R Dingankar, Dominic A Cave, Vijay Anand, V Ben Sivarajan, Susan Nahirniak, Cathy Sheppard, Jan Hanot, and Garcia Guerra Gonzalo G Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. Pediatric.
• Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
• Pediatr Crit Care Me. 2018 Sep 1; 19 (9): 846-853.

ObjectivesTo determine the clinical benefit of using colloids versus crystalloids for volume resuscitation in children admitted after cardiac surgery.DesignRetrospective pre-/postintervention cohort study.SettingStollery Children's Hospital tertiary care pediatric cardiac ICU.PatientsChildren admitted to the pediatric cardiac ICU after cardiac surgery.InterventionsFluid resuscitation policy change in which crystalloids replaced albumin 5% as the primary fluid strategy for resuscitation after cardiac surgery.Measurements And Main ResultsChildren who underwent cardiac surgery in the 6 months prior to the policy change (5% albumin group) were compared with children admitted during the 6 months after (crystalloid group). Demographic, perioperative, and outcome variables (fluid intake days 1-4 postoperative, vasoactive therapy, blood products, time to negative fluid balance, renal replacement therapies, mechanical ventilation, pediatric cardiac ICU, and length of stay) were collected. Data were analyzed using linear and logistic multivariate analysis. The study included 360 children. There was no association between fluid group and fluid intake (mL/kg) on day 1 postoperatively (coefficient, 2.84; 95% CI, 5.37-11.05; p = 0.497). However, crystalloid group was associated with significantly less fluid intake on day 2 (coefficient, -12.8; 95% CI, -22.0 to -3.65; p = 0.006), day 3 (coefficient, -14.9; 95% CI, -24.3 to -5.57; p = 0.002), and on the first 48 hours postoperative (coefficient, 10.1; 95% CI, -27.9 to -1.29; p = 0.032). Pediatric cardiac ICU stay (coefficient, -1.29; 95% CI, -2.50 to -0.08; p = 0.036) was shorter for the crystalloid group. There were no significant differences in the time to negative balance, need for renal replacement therapy, mechanical ventilation days, hospital stay, or pediatric cardiac ICU survival.ConclusionsIn our study, the use of albumin 5% for resuscitation after cardiac surgery was not associated with less fluid intake but rather the opposite. Albumin administration did not provide measured clinical benefit while exposing children to side effects and generating higher costs to the healthcare system.

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