Related Experiment Video
Updated: May 30, 2025
Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis
Published on: August 17, 2022
Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children
Insights
Fluid overload is common in pediatric intensive care units (PICUs), with varying rates across facilities. Addressing site-specific fluid balance drivers is crucial for effective management and improved patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Fluid Management
Background:
- Fluid overload (FO) is a significant complication in Pediatric Intensive Care Units (PICUs), linked to increased morbidity and mortality.
- Accurate fluid balance (FB) reporting and management are challenging due to unique institutional needs, barriers, and limitations.
Purpose of the Study:
- To investigate the prevalence of positive cumulative fluid balance (CFB) within the initial days of PICU admission.
- To identify site-specific drivers of positive CFB, barriers to accurate FB recording, and opportunities for improvement.
Main Methods:
- A concurrent mixed methods study combining retrospective observational data and prospective interviews/surveys across four tertiary pediatric ICUs.
- Fluid balance data extracted from electronic health records using a federated data collection framework.
- Primary outcome: %CFB on PICU days 1 and 2, calculated as (total intake - total output) / PICU admission weight.
Main Results:
- Day 2 CFB >5% ranged from 39% to 54% (p=0.03) and >10% from 16% to 25% (p=0.04) across sites.
- Significant inter-site variations observed in urine output recording and fluid administration protocols (p<0.001).
- While discussion frequency of FB goals varied, reported barriers and improvement opportunities were similar across sites.
Conclusions:
- Positive fluid balance is prevalent in PICU patients, with significant variability in its proportion across different ICUs.
- Effective management of FO requires targeting the unique drivers of positive fluid balance at each individual pediatric intensive care unit.
Introduction:
Fluid overload (FO), a state of pathologic positive cumulative fluid balance (CFB), is common in Pediatric Intensive Care Units (PICU) and associated with morbidity and mortality. Because different PICUs may have unique needs, barriers, and limitations to accurately report fluid balance (FB) and reduce FO, understanding the drivers of positive FB is needed. We hypothesize CFB >5% and >10% is common on ICU days 1 and 2, but that reasons for high %CFB will vary across sites, as will barriers to accurate FB recording and opportunities to improve FB recording/management.
Methods:
Concurrent mixed methods study utilizing a retrospective observational cohort design and prospective interview and survey design performed at four tertiary pediatric ICUs. FB data was extracted from the electronic health record. A federated data collection framework allowed for rapid data aggregation. The primary outcome was %CFB on ICU days 1 and 2, defined as total intake minus total output divided by ICU admission weight. Chi-square test and Wilcoxon rank sum tests compared results across and within sites.
Results:
Amongst 3,071 ICU encounters, day 2 CFB >5% varied from 39% to 54% (p=0.03) and day 2 CFB >10% varied from 16% to 25% (p=0.04) across sites. Urine occurrence recordings and patients receiving >100% Holliday-Segar fluids on Day 1 differed across sites (p<0.001). Sites discussed overall FB and specific FB goals on rounds with differing frequency (42-73% and 19-39%, respectively), but they reported similar barriers to accurate FB reporting and achievable opportunities to improve FB measurements, including patients/families not saving urine/stool, patients not tracking oral intake, and lack of standardized charting of flushes.
Conclusion:
Day 2 CFB >5% and >10% was common among pediatric ICU encounters but proportion of patients varied significantly across ICUs. Individual ICUs have different drivers of FO that must be targeted to improve FB management.
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