Lee, Jiwon M.
(Department of Pediatrics, Seoul National University Children's Hospital)
,
Jung, Younghwa
(Department of Pediatrics, Seoul National University Children's Hospital)
,
Lee, Se Eun
(Department of Pediatrics, Seoul National University Children's Hospital)
,
Lee, Jun Ho
(Department of Pediatrics, CHA Bundang Medical Center, CHA University)
,
Kim, Kee Hyuck
(Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital)
,
Koo, Ja Wook
(Department of Pediatrics, Inje Unversity Sanggye Paik Hospital, Inje Unversity College of Medicine)
,
Park, Young Seo
(Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
,
Cheong, Hae Il
(Department of Pediatrics, Seoul National University Children's Hospital)
,
Ha, Il-Soo
(Department of Pediatrics, Seoul National University Children's Hospital)
,
Choi, Yong
(Department of Pediatrics, Seoul National University Children's Hospital)
,
Kang, Hee Gyung
(Department of Pediatrics, Seoul National University Children's Hospital)
Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatri...
Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatric residents and to call for updated clinical practice education Methods: A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question supposed a unique scenario in which the respondents were to prescribe either a hypotonic or an isotonic fluid for the patient. Results: Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. Conclusion: In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.
Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatric residents and to call for updated clinical practice education Methods: A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question supposed a unique scenario in which the respondents were to prescribe either a hypotonic or an isotonic fluid for the patient. Results: Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. Conclusion: In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.
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제안 방법
The survey data were cross-tabulated by question and fluid option. For the purposes of the analysis, the solutions were categorized as either hypotonic (NAK2, NAK3) or isotonic (NS, 5% NS).
The respondents were informed that their identities were to remain anonymous. The survey data were cross-tabulated by question and fluid option. For the purposes of the analysis, the solutions were categorized as either hypotonic (NAK2, NAK3) or isotonic (NS, 5% NS).
대상 데이터
A paper-based survey comprising four questions was distributed to residents in-training at six university hospitals in Korea: Seoul National University Hospital, Asan Medical Center, Dongguk University Ilsan Hospital, CHA Bundang Medical Center, Myongji Hospital, and Inje University Ilsan Paik Hospital. Each question introduced a clinical scenario in which the respondent was to choose the most appropriate fluid: 1) a six-month-old baby with acute bronchiolitis, 2) a five-year-old child with Henoch-Schöen-lein purpura and abdominal pain; 3) a three-year-old who just received a surgery from acute appendicitis, and 4) a one-year-old infant with acute gastroenteritis and dehydration (Appendix).
The four clinical scenarios presented in the survey were all examples of the above-noted AVP-excess conditions9,14). Ill children can have multiple nonosmotic triggers for AVP secretion11).
이론/모형
The survey was designed and structured by Y. Choi (Appendix). The respondents were informed that their identities were to remain anonymous.
후속연구
In any event, it is critical to monitor a patient’s electrolytes once intravenous fluid administration has been initiated. The overall findings of our survey suggest that current advances in fluid management have limited reach and application in the resident training environments and that they need to be emphasized and imparted, especially to front-line practitioners. We hope that the present work will alert clinicians and primary medical practitioners to the need for programmed education and updated clinical practice guidelines on intravenous fluid prescription.
The overall findings of our survey suggest that current advances in fluid management have limited reach and application in the resident training environments and that they need to be emphasized and imparted, especially to front-line practitioners. We hope that the present work will alert clinicians and primary medical practitioners to the need for programmed education and updated clinical practice guidelines on intravenous fluid prescription.
참고문헌 (16)
1 Holliday MA Segar WE The maintenance need for water in parenteral fluid therapy Pediatrics 1957 19 823 832 13431307
4 Kannan L Lodha R Vivekanandhan S Bagga A Kabra SK Kabra M Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial Pediatr Nephrol 2010 25 2303 2309 20668885
5 Neville KA Verge CF Rosenberg AR O'Meara MW Walker JL Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study Arch Dis Child 2006 91 226 232 16352625
11 Moritz ML Ayus JC Hospital-acquired hyponatremia: why are hypotonic parenteral fluids still being used? Nat Clin Pract Nephrol 2007 3 374 382 17592470
14 Choong K Kho ME Menon K Bohn D Hypotonic versus isotonic saline in hospitalised children: a systematic review Arch Dis Child 2006 91 828 835 16754657
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