Prospective Cohort Study on Cumulative Fluid Balance and Outcome in Critically Ill Children Using a Restrictive Fluid...

Area of Science:

• Pediatric Intensive Care
• Critical Care Medicine
• Fluid Management

Background:

• Fluid overload is a common complication in pediatric intensive care units (PICUs).
• The impact of cumulative fluid balance on clinical outcomes in PICU patients under a restrictive fluid protocol requires further investigation.

Purpose of the Study:

• To investigate the association between cumulative fluid balance and clinical outcomes in children admitted to a PICU with a restrictive fluid protocol.
• To determine if fluid balance within a specific threshold affects mortality and morbidity.

Main Methods:

• A prospective cohort study involving children under 13 years admitted for over 48 hours.
• Exclusion of patients with unstable hemodynamics.
• Calculation of cumulative fluid balance as percentage fluid overload (%FO) over the first 7 days.
• Comparison of outcomes between positive and negative fluid balance groups, with all-cause 28-day mortality as the primary outcome.

Main Results:

• No significant difference in all-cause 28-day mortality between the positive (19.6%) and negative (16.8%) fluid balance groups.
• Similar rates of organ dysfunction, acute kidney injury, need for renal replacement therapy, and duration of ventilation between groups.
• Patients with positive fluid balance experienced longer PICU and hospital stays.

Conclusions:

• A cumulative fluid balance within 3% in a pediatric intensive care unit utilizing a restrictive fluid protocol is not associated with significant differences in mortality.
• While not impacting mortality or major organ dysfunction, positive fluid balance correlated with extended hospital and PICU lengths of stay.