Fluid restriction after pediatric cardiac surgery is independently associated With shorter mechanical ventilation: a retrospective cohort study With adjustment for cardiopulmonary bypass time.

Background: Cardiopulmonary bypass (CPB) for pediatric cardiac surgery triggers a systemic inflammatory response driving postoperative fluid retention, prolonged ventilation, and acute kidney injury (AKI). The Starship Hospital guideline provides a structured framework for postoperative fluid restriction, but North American observational validation adjusting for CPB time has been lacking. Objective: To evaluate the association between a Starship-derived fluid restriction protocol and clinical outcomes, with adjustment for operative complexity. Methods: Retrospective single-center cohort of 329 pediatric patients undergoing structural CHD surgery with cardiopulmonary bypass (April 2017-February 2025): 259 pre-protocol, 70 post-protocol. Non-CPB lateral thoracotomy cases were excluded Results: Mean CPB time was shorter post-protocol (83.0 vs. 101.2 min; Conclusions: A Starship-derived fluid restriction protocol was independently associated with shorter mechanical ventilation, reduced furosemide exposure, and reduced hypernatremia, robust to full adjustment for operative covariates. AKI and LOS effects attenuated under full adjustment. Findings are hypothesis-generating and support proactive fluid restriction as a candidate intervention warranting prospective evaluation.