Fluid overload and outcomes in critically ill children: A single center prospective cohort study

Area of Science:

• Pediatric Critical Care Medicine
• Nephrology
• Intensive Care

Background:

• Fluid overload (FO) is a frequent complication in pediatric intensive care units (PICUs).
• The association between FO and clinical outcomes, including mortality, requires further investigation.
• Understanding FO's impact is crucial for optimizing patient management in critical care settings.

Purpose of the Study:

• To prospectively evaluate the association between fluid overload (FO) and clinical outcomes in a pediatric intensive care unit (PICU).
• To determine if FO predicts mortality, mechanical ventilation (MV) duration, and length of stay (LOS).

Main Methods:

• Prospective inclusion of 224 patients requiring MV for >24 hours or vasoactive support.
• Daily calculation of FO using the formula: [(fluid in-fluid out)/admission weight]×100%.
• Multivariate logistic regression analysis to identify independent predictors of survival.

Main Results:

• The median peak FO (PFO) was 12.5%, with 55.8% of patients experiencing PFO >10%.
• No significant association was found between PFO and mortality in survival analysis.
• FO was associated with increased MV duration and PICU LOS, but not an independent predictor of mortality. Vasoactive support, >3 organ failures, and AKI were independent risk factors.

Conclusions:

• Fluid overload is prevalent in the general PICU population, but peak fluid overload is not an independent risk factor for mortality.
• Future research on FO should concentrate on critically ill patients with acute kidney injury (AKI) and multiorgan failure.
• This may lead to better severity classification and targeted interventions for fluid overload management.