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Updated: Dec 26, 2025
Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis
Published on: August 17, 2022
Profile of Fluid Exposure and Recognition of Fluid Overload in Critically Ill Children
Zahraa H Al-Lawati1,2, Moushumi Sur2, Curtis E Kennedy2
1Department of Pediatrics/Division of Critical Care, Wayne State University, Detroit, MI.
Insights
Fluid overload is common in pediatric intensive care units (PICUs), with significant fluid exposure often exceeding maintenance needs by day 3. Clinicians failed to recognize fluid overload in 30% of cases, highlighting a critical care gap.
Area of Science:
- Pediatric Critical Care Medicine
- Fluid Management in Intensive Care
- Patient Safety and Clinical Recognition
Background:
- Fluid overload is a prevalent issue in pediatric intensive care units (PICUs), linked to increased morbidity and mortality.
- The precise role of fluid overload—whether a marker of illness severity, an iatrogenic factor, or a consequence of oliguria—remains unclear.
- The contribution of different fluid types to overload and its clinical recognition require further investigation.
Purpose of the Study:
- To quantify fluid exposure types and amounts in the PICU.
- To assess the recognition of fluid overload by clinicians in pediatric patients.
- To investigate the relationship between fluid administration and overload development.
Main Methods:
- A prospective observational study conducted over 28 days in a noncardiac PICU.
- Data collected on fluid exposure (resuscitative, blood, enteral, parenteral, IV fluids, medications) indexed to body surface area on days 1 and 3.
- Chart review of patients developing 15% fluid overload to evaluate clinician recognition.
Main Results:
- 102 pediatric patients were included; Day 1 median fluid exposure was 2,318 mL/m, with 1,646 mL/m from modifiable fluids.
- Day 3 median fluid exposure was 2,233 mL/m, with 750 mL/m from modifiable fluids; 87% of patients exceeded 1,600 mL/m.
- Clinicians failed to recognize fluid overload in 30% of patients who developed >15% fluid overload.
Conclusions:
- While resuscitation fluids contributed more on Day 1, fluid exposure frequently exceeded maintenance requirements by Day 3.
- Fluid overload was not consistently recognized by PICU practitioners, indicating a potential gap in care.
- Further research is needed to link modifiable fluid exposure to overload and identify practice improvement opportunities.
Objectives:
Fluid overload is common in the PICU and has been associated with increased morbidity and mortality. It remains unclear whether fluid overload is a surrogate marker for severity of illness and need for increased support, an iatrogenic modifiable risk factor, or a sign of oliguria. The proportions of various fluid intake contributing to fluid overload and its recognition have not been adequately examined. We aimed to: 1) describe the types and amounts of fluid exposure in the PICU and 2) identify the clinicians' recognition of fluid overload.
Setting:
Noncardiac PICU in a quaternary care hospital.
Patients:
Pediatric patients admitted for more than 24 hours.
Design:
Prospective observational study over 28 days.
Interventions:
Data were collected on the amount and type of fluid exposure-resuscitative boluses, blood products, enteral intake, parenteral nutrition (total parenteral nutrition), or modifiable fluids (IV fluids and medications) indexed to the patients' admission body surface area on days 1 and 3. Charts of patients admitted for 3 days who developed 15% fluid overload were reviewed to assess clinicians' recognition of fluid overload.
Measurements And Main Results:
One hundred two patients were included. Day 1 median fluid exposure was 2,318 mL/m (1,831-3,037 mL/m; 1,646 mL/m [1,296-2,086 mL/m] modifiable fluids). Forty-seven patients (46%) received fluid boluses, and 16 (16%) received blood products. Day 3 median fluid exposure was 2,233 mL/m (1,904-2,556 mL/m; 750 mL/m [375-1,816 mL/m] modifiable fluids). Of the 54 patients, one patient (1.9%) received a fluid bolus and two (3.7%) received blood products. In our cohort, 47 of 54 (87%) had fluid exposure greater than 1,600 mL/m on day 3. Fluid overload was not recognized by the clinicians in 30% of the patients who developed more than 15% fluid overload.
Conclusions:
Although resuscitation fluids contributed more to fluid exposure on day 1 compared with day 3, fluid exposure frequently exceeded maintenance requirements on day 3. Fluid overload was not always recognized by PICU practitioners. Further studies to correlate modifiable fluid exposure to fluid overload and explore modifiable practice improvement opportunities are needed.
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