The Effect of Fluid Therapy on the Development of Metabolic Disturbances and ICU Length of Stay in Pediatric Patients Undergoing Surgery for Congenital Heart Defects

Aim: to compare the effects of restrictive versus liberal fluid therapy on the duration of mechanical ventilation (MV), total intensive care unit (ICU) stay, and the need for inotropic and vasopressor support during the post-perfusion period and the first 24 hours after surgery in young children undergoing surgical correction of congenital heart defects (CHD). Materials and Methods. A prospective, randomized, single-center study included pediatric patients (toddlers) with CHD who were assigned to one of two groups. Group 1 received fluid therapy according to a restrictive protocol (RP group, N=65) at 8 mL/kg/h, while group 2 received therapy according to a liberal protocol (LP group, N=67) at 16 mL/kg/h. The study evaluated the dynamics of metabolic disturbances, duration of ventilatory support, postoperative weight gain, and total ICU stay. Results. Mechanical ventilation time and total ICU stay were longer in the RP group compared to the LP group: 14±5 hours vs. 10±3 hours (P=0.035) and 27±4 hours vs. 23±2 hours (P=0.036), respectively. Mean postoperative weight gain in the LP group was 2.00% vs 0.32% in the RP group (P=0.001). No clinically significant metabolic or electrolyte disturbances were observed in either group, except for elevated K ion levels in the LP group. Conclusion. These findings contradict previously reported data in adult population with CHD. In toddlers, a liberal approach to fluid therapy resulted in shorter duration of ventilation and ICU stay compared to a restrictive approach. Toddlers are more sensitive to fluid volume and their preload requirements are higher than those of adults.