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Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative
Yeu Sanz Wu1, Tania Gennell1, Chloe Porigow1
1Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian-Morgan Stanley Children's Hopsital, New York, NY.
Insights
Critically ill pediatric trauma and surgical patients show similar fluid management and balance post-injury or surgery. These groups may be combined for future studies on optimal fluid therapy in children.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Pediatric Surgery
Background:
- Fluid management is crucial in critically ill pediatric patients following injury or surgery.
- The inflammatory response to intravenous (IV) fluids in these populations is not well-understood.
- Comparing fluid management strategies in trauma versus surgical pediatric patients is necessary.
Purpose of the Study:
- To compare fluid management strategies in critically ill pediatric trauma and surgical patients.
- To analyze total IV fluid volume, net fluid balance, and clinical outcomes.
- To determine if fluid requirements and responses differ between these two groups.
Main Methods:
- Retrospective cohort study conducted from January 2020 to July 2022.
- Inclusion of critically ill pediatric patients (0-18 years) admitted to the PICU.
- Data collection on total IV fluid administered, net fluid balance, and clinical outcomes.
Main Results:
- No significant difference in total IV fluids administered or fluid balance between trauma and surgical groups in the first 5 days.
- Both groups exhibited a similar transition from net positive to net negative fluid balance between 48 and 72 hours.
- A correlation was found between total IV fluid administration and the need for mechanical ventilation.
Conclusions:
- Critically ill pediatric trauma and postoperative patients demonstrate comparable fluid management and balance.
- These patient populations may be suitable for combined analysis in large prospective studies.
- Further research is warranted to optimize fluid therapy in critically ill children.
Objective:
Injury and surgery both represent well-defined starting points of a predictable inflammatory response, but the consequent response to IV fluids has not been studied. We aimed to review and compare our single-center fluid management strategies in these two populations.
Design:
Retrospective cohort study from January 2020 to July 2022. The primary outcome was total IV fluid volume administered. Net fluid balances and select clinical outcomes were also evaluated.
Setting:
Single tertiary academic center and level 1 pediatric trauma center in New York.
Patients:
A dataset of critically ill trauma and surgical patients aged 0-18 years who were admitted to the PICU, 2020-2022. Trauma patients had at least moderate traumatic injuries (Injury Severity Score ≥ 9) and surgical patients had at least a 1-hour operation time.
Interventions:
None.
Measurements And Main Results:
We identified 25 trauma and 115 surgical patients. During the first 5 days of hospitalization, we did not identify an association between grouping and total IV fluids administered and fluid balance in the prehospital, emergency department, and operating room ( p = 0.90 and p = 0.79), even when adjusted for weight ( p = 0.96). Time trend graphs of net fluid balance and IV fluid administered illustrated analogous fluid requirement and response with the transition from net positive to net negative fluid balance between 48 and 72 hours. There was an association between total IV fluid and ventilator requirement ( p = 0.003).
Conclusions:
Critically ill pediatric trauma and postoperative patients seem to have similar fluid management and balance after injury or surgery. In our opinion, these two critically ill populations could be combined in large prospective studies on optimal fluid therapy in critically ill children.
