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Restricted versus Usual/Liberal Maintenance Fluid Strategy in Mechanically Ventilated Children: An Open-Label

Shubham Charaya1, Suresh Kumar Angurana2, Karthi Nallasamy3

  • 1Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.

Indian Journal of Pediatrics
|October 18, 2023
PubMed

Insights

A restricted fluid strategy in mechanically ventilated children showed a trend towards lower fluid overload and mortality. This approach also led to significantly more ventilation-free and PICU-free days, indicating better recovery.

Area of Science:

  • Pediatric Critical Care Medicine
  • Fluid Management
  • Mechanical Ventilation

Background:

  • Fluid overload (FO) is a common complication in mechanically ventilated children.
  • Optimal fluid management strategies are crucial for improving outcomes in critically ill children.

Purpose of the Study:

  • To compare the impact of a restricted versus a usual/liberal maintenance fluid strategy on fluid overload in mechanically ventilated children.

Main Methods:

  • An open-label randomized controlled trial involving 100 hemodynamically stable, mechanically ventilated children in a North Indian Pediatric Intensive Care Unit (PICU).
  • Children were randomized to receive either 40% (restricted group) or 70-80% (usual/liberal group) of maintenance fluids.
  • Primary outcome was cumulative fluid overload percentage (FO%) at day 7; secondary outcomes included organ dysfunction scores, ventilation-free days (VFDs), PICU-free days (PFDs), and mortality.

Main Results:

  • The restricted group showed a non-significant trend towards lower cumulative FO% (7.6% vs. 9.5%) and a lower proportion of children with FO% >10% (12% vs. 26%) compared to the usual/liberal group.
  • The restricted group received significantly less fluid volume in the first 5 days and had significantly more VFDs (23 vs. 17 days) and PFDs (19 vs. 15 days).
  • A trend towards lower mortality was observed in the restricted group (8% vs. 16%).

Conclusions:

  • A restricted maintenance fluid strategy in mechanically ventilated children is associated with a trend towards reduced fluid overload and mortality.
  • This strategy also leads to significantly improved ventilation-free and PICU-free days.
  • Restricted fluid administration appears beneficial in this pediatric population, warranting further investigation.
Abstract

Keywords:
Critically ill childrenFluid creepFluid overloadMaintenance fluidsMechanical ventilation

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