Consensus recommendations for pediatric fluid resuscitation in Belgium : On behalf of the Be-PIV group

Abstract

Fluid resuscitation is an important part of pediatric critical care therapy and shock treatment. To date, there are no Belgian guidelines on this topic. As children’s (patho)physiology differs from adults, existing recommendations for adults should not be carelessly adapted. Although no superiority has been found for a specific type of fluid, strong recommendations against dextrose-containing fluids, hypotonic fluids and starch-based colloids have been uniformly accepted due to their safety profile and/or cost. There is also considerable debate about rate and volume of fluid boluses needed during resuscitation where a distinction is often made based on access to pediatric critical care units. As these are widely accessible in Belgium, we do not make this distinction but advocate early contact or transfer.

If a child requires fluid resuscitation, we recommend using boluses of 10 ml/kg balanced crystalloids with careful reassessment after each bolus to assess fluid responsiveness as well as signs of fluid overload. The choice should be tailored to the child´s underlying illness since specific situations may necessitate specific treatment, as is shown in the proposed algorithm.C