Fluid accumulation in critically ill children: a systematic review and meta-analysis

Area of Science:

• Pediatric Critical Care Medicine
• Nephrology
• Intensive Care Medicine

Background:

• Critically ill children are susceptible to fluid accumulation (FA), which is linked to adverse outcomes.
• FA can lead to organ dysfunction, prolonged mechanical ventilation, extended hospital stays, and increased mortality.
• Understanding the association between FA and poor outcomes is vital for pediatric intensive care.

Purpose of the Study:

• To assess the association between fluid accumulation (FA) and poor outcomes in critically ill children.
• To synthesize evidence from systematic review and meta-analysis on FA and pediatric critical illness outcomes.
• To identify the impact of FA on mortality, organ dysfunction, and resource utilization in pediatric intensive care.

Main Methods:

• Systematic review and meta-analysis of studies from PubMed, Embase, ClinicalTrials.gov, and Cochrane Library (inception to May 2024).
• Inclusion of pediatric studies assessing the effect of FA on outcomes like mortality, acute kidney injury, and mechanical ventilation.
• Pooled analyses using random-effects models to determine the association between FA and adverse outcomes.

Main Results:

• 120 studies (44,682 children) were included, identifying 35 FA definitions.
• FA was significantly associated with increased mortality (OR 4.36), acute kidney injury (OR 1.98), prolonged mechanical ventilation (38.1 h), and longer ICU stays (2.29 days).
• Each 1% increase in FA percentage was associated with a 6% increased odds of mortality in adjusted analyses (aOR 1.06).

Conclusions:

• Fluid accumulation is a significant predictor of poorer outcomes in critically ill children.
• Clinicians should monitor fluid balance closely, especially in oedematous patients with organ dysfunction, to identify potential FA syndrome.
• Preventive measures and further research into interventions like restrictive fluid therapy are recommended to mitigate FA.