A Standardized Approach to Reduce Fluid Overload in Critically Ill Children

Area of Science:

• Pediatric Critical Care Medicine
• Quality Improvement Science
• Fluid Balance Management

Background:

• Fluid overload is prevalent in pediatric intensive care units (PICUs), significantly correlating with adverse patient outcomes.
• Current quality improvement processes for monitoring fluid balance in critically ill children are insufficient.

Purpose of the Study:

• To develop and implement a comprehensive fluid management strategy within the PICU.
• To achieve at least 50% adherence to the new strategy among all PICU patients.

Main Methods:

• The strategy incorporated four key components: a fluid balance dashboard, daily weight documentation, integrated fluid balance reporting during rounds, and active total intravenous (IV) fluid orders.
• Implementation involved integrating daily weights and total IV fluid orders into PICU admission order sets.

Main Results:

• The study reviewed 280 patient encounters from May 2023 to April 2024.
• The primary aim of achieving at least 50% compliance with the fluid management strategy was met and sustained.
• Compliance was associated with the implementation of daily weights and total IV fluid orders in admission sets.

Conclusions:

• A quality improvement-based fluid management strategy was successfully developed, implemented, and maintained.
• Future efforts will focus on daily dashboard use and monitoring compliance with IV fluid orders.
• This strategy has the potential to enhance patient fluid status awareness and optimize fluid therapy to prevent detrimental fluid overload.