Efficacy and safety of drinking ice-carbonated water and ice-purified water immediately after extubation in paediatric patients with congenital heart disease: a randomised, controlled three-arm trial

BACKGROUND: Children who undergo congenital heart disease (CHD) surgery face increased postoperative thirst, which can cause discomfort and lead to serious consequences. There is a lack of effective thirst management strategies for this vulnerable group. OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of ice‐carbonated water and ice‐purified water in alleviating thirst in children following CHD surgery. METHODS: A randomized controlled trial with three parallel arms was conducted at a tertiary medical center in China between August and December 2022. A total of 108 children aged 3‐12 years who had undergone congenital heart disease surgery and were conscious with a thirst numeric rating scale (NRS) score ≥3 were included in the study. Participants were randomly assigned to drink ice‐carbonated water (H2O‐ice‐carb group), ice‐purified water (H2O‐ice group), or receive conventional care (control group). Interventions were administered five times: immediately after extubation following the assessment of the safety protocol for paediatric thirst management, and then at 1, 2, 3, and 4 hours post‐extubation. Outcomes were assessed at six time points: T0 (baseline, immediately after extubation, prior to the safety protocol for paediatric thirst management assessment and any intervention) and T1‐T5 (after each of the five interventions). Primary outcomes were NRS scores for thirst and oral moisture, while secondary outcomes included oral comfort, saliva pH, and adverse events. RESULTS: A generalised estimating equation analysis demonstrated group‐by‐time interactions for both primary outcomes. At T5, the between‐group difference in thirst NRS was ‐4.71 points (95% confidence interval [CI]: ‐5.12 to ‐4.30) for H2O‐ice‐carb group vs. control group and ‐3.86 points (95% CI: ‐4.36 to ‐3.35) for H2O‐ice group vs. control group (both P < 0.001). The H2O‐ice‐carb group demonstrated greater improvement than the H2O‐ice group (difference = ‐0.85; 95% CI: ‐1.26 to ‐0.44; P < 0.001), with the difference apparent from T1 (P = 0.009). For oral moisture, the H2O‐ice‐carb group showed the strongest effect (2.51% per hour), followed by the H2O‐ice group (1.66% per hour; both P < 0.001). No differences in adverse events were found among the three groups (P = 0.364). CONCLUSIONS: Immediate consumption of ice‐carbonated and ice‐purified water following extubation effectively and safely alleviates postoperative thirst in children after CHD surgery, with ice‐carbonated water showing better results. These findings may inform the development of postoperative fasting and fluid management protocols for paediatric patients.