Selection of infusion therapy regimen in the postoperative period in children with congenital heart defects

BACKGROUND: The choice of infusion therapy regimen in neonates and infants after cardiac surgery remains a relevant challenge. The use of balanced crystalloid solutions in combination with an optimized infusion regimen may improve metabolic and hemodynamic parameters as well as myocardial contractility.

AIM: This work aimed to evaluate the effectiveness of an optimized restrictive infusion regimen with balanced crystalloid solutions in neonates and infants during the early postoperative period after cardiac surgery for congenital heart defects.

METHODS: This prospective cohort study included 61 children with transposition of the great arteries and total anomalous pulmonary venous return, who underwent radical cardiac surgery. Patients were allocated into groups according to the type of solution and infusion protocol used: the control group received 0.9% sodium chloride solution using a standard regimen, whereas the main group received Ringer’s balanced solution according to the optimized method (1 ml/[kg × h] + 1 ml/[kg × h] for inotropic support).

RESULTS: Patients treated with the balanced solution under the optimized regimen demonstrated more pronounced improvements in pH and base deficit, stable potassium, sodium, and chloride levels, less pronounced tachycardia, and normalization of central venous pressure. Echocardiographic parameters at 24 hours indicated improved end-diastolic volume, end-diastolic index, and ejection fraction. Extubation time was reduced by 20.2%, and length of stay in intensive care units was reduced by 14.3%.

CONCLUSION: The combination of balanced crystalloids with a restrictive infusion regimen in neonates and infants after correction of congenital heart defects promotes a more physiological restoration of homeostasis, reduces the need for inotropic support, and improves cardiohemodynamic parameters in the early postoperative period.