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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.
Current Opinion in Critical Care
|October 27, 2022
Summary
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.
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