Associations Between Fluid Balance and Outcomes in Critically Ill Children: A Protocol for a Systematic Review and
Rashid Alobaidi1, Catherine Morgan2, Rajit K Basu3
1Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Insights
Fluid overload in critically ill children is linked to higher mortality. This systematic review synthesizes evidence on fluid balance measurement and its impact on pediatric intensive care unit outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Evidence Synthesis
- Systematic Review Methodology
Background:
- Fluid therapy is essential for critically ill children.
- Excessive fluid accumulation (fluid overload) is associated with increased mortality and morbidity.
- Standardized definitions and measurement methods for fluid balance are lacking.
Purpose of the Study:
- To synthesize evidence on methods for measuring fluid balance in critically ill children.
- To define fluid overload in the context of pediatric critical care.
- To evaluate the association between fluid balance and patient outcomes.
Main Methods:
- Systematic review and meta-analysis of clinical trials and observational studies.
- Searched multiple databases including MEDLINE, EMBASE, Cochrane Library, and clinical trial registries.
- Included studies involving patients (<25 years) in pediatric intensive care units (PICUs) reporting fluid balance and outcomes.
Main Results:
- The review will identify various methods used to measure fluid balance, accumulation, and overload.
- It will assess the association between fluid balance and outcomes such as mortality and resource utilization.
- Expected heterogeneity and variations in definitions will be addressed.
Conclusions:
- The quality of evidence, particularly the lack of randomized trials, presents limitations.
- Harmonizing definitions of fluid balance, accumulation, and overload is a key objective.
- This synthesis aims to provide a comprehensive appraisal of the evidence linking fluid balance to outcomes in critically ill children.
Background:
Fluid therapy is a mainstay during the resuscitation of critically ill children. After initial stabilization, excessive fluid accumulation may lead to complications of fluid overload, which has been independently associated with increased risk for mortality and major morbidity in critically ill children.
Objectives:
Perform an evidence synthesis to describe the methods used to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children.
Design:
Systematic review and meta-analysis.
Measurements:
Fluid balance, fluid accumulation, and fluid overload as defined by authors.
Methods:
We will search Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and ProQuest, Dissertations and Theses. In addition, we will search www.clinicaltrials.gov, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and the proceedings of selected key conferences for ongoing and completed studies. Search strategy will be done in consultation with a research librarian. Clinical trials and observational studies (from database inception to present) in patients (<25 years) admitted to pediatric intensive care units (PICUs) reporting fluid balance, fluid accumulation, or fluid overload, and associated outcomes will be included. Language will not be restricted. Two reviewers will independently screen studies and extract data. Primary outcome is mortality, and secondary outcomes encompass critical care resource utilization. Quality of evidence and risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS). Results will be synthesized qualitatively and pooled for meta-analysis if possible.
Limitations:
Quality of the included studies; lack of randomized trials; high degrees of expected heterogeneity; and variations in definitions of fluid balance and fluid overload between studies.
Conclusion:
We will comprehensively appraise and summarize the evidence of the association between fluid balance and outcomes in critically ill children, and in doing so attempt to harmonize definitions related to fluid balance, accumulation, and overload.
Systematic Review Registration:
PROSPERO: CRD42016036209.
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