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Fluid balance in pediatric critically ill patients (with and without kidney dysfunction)
Zaccaria Ricci1,2, Erica Bjornstad3
1Pediatric Intensive Care Unit, Meyer Children's University Hospital.
Insights
Fluid overload is a critical concern in critically ill children, impacting outcomes. Further research is needed to establish optimal fluid management strategies and decongestion timing for better patient survival.
Area of Science:
- Pediatric critical care medicine
- Nephrology
- Fluid physiology
Background:
- Fluid balance and overload are critical in pediatric critical care.
- Understanding their impact on patient outcomes is essential.
Approach:
- This review synthesizes current evidence on fluid management in critically ill children.
- It examines definitions, monitoring, and treatment of positive fluid balance.
- Focuses on high-risk populations: perioperative cardiac surgery, acute respiratory failure, and ECMO.
Key Points:
- Fluid overload poses significant risks in pediatric critical care.
- Evidence is primarily from retrospective/observational studies.
- Gaps exist in defining overload thresholds and optimal decongestion timing.
Conclusions:
- Active decongestion may improve outcomes, but requires robust clinical trials.
- Randomized controlled trials are needed to guide optimal fluid management.
- Further research is crucial for improving mortality and clinical outcomes in fluid-overloaded pediatric patients.
Purpose Of Review:
The issues of fluid balance and fluid overload are currently considered crucial aspects of pediatric critically ill patients' care.
Recent Findings:
This review describes current understanding of fluid management in critically ill children in terms of fluid balance and fluid overload and its effects on patients' outcomes. The review describes current evidence surrounding definitions, monitoring, and treatment of positive fluid balance. In particular, the review focuses on specific patient conditions, including perioperative cardiac surgery, severe acute respiratory failure, and extracorporeal membrane oxygenation therapy, as the ones at highest risk of developing fluid overload and poor clinical outcomes. Gaps in understanding include specific thresholds at which fluid overload occurs in all critically ill children or specific populations and optimal timing of decongestion of positive fluid balance.
Summary:
Current evidence on fluid balance in critically ill children is mainly based on retrospective and observational studies, and intense research should be recommended in this important field. In theory, active decongestion of patients with fluid overload could improve mortality and other clinical outcomes, but randomized trials or advanced pragmatic studies are needed to better understand the optimal timing, patient characteristics, and tools to achieve this.
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