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Impact of Fluid Overload on Mortality Among Critically Ill Pediatric Patients: An Observational Study at a Tertiary

Anitha Rajendran1, Pratibha Bamne1, Nitesh Upadhyay1

  • 1Pediatrics, Gandhi Medical College, Bhopal, IND.

Cureus
|May 15, 2025
PubMed

Insights

Fluid overload in pediatric intensive care units significantly predicts mortality. Early monitoring of 24-hour fluid overload is crucial for managing critically ill children and improving outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Intensive Care

Background:

  • Fluid overload (FO) is a major concern in pediatric intensive care units (PICUs), linked to increased morbidity and mortality.
  • Excessive fluid accumulation worsens organ dysfunction, impacting cardiovascular, respiratory, and renal systems.
  • Limited data exist on FO in critically ill children, especially in low-resource settings.

Purpose of the Study:

  • To assess the prevalence of significant cumulative FO percentage in critically ill children.
  • To determine the association between FO and mortality, Pediatric Risk of Mortality (PRISM-III) score, and PICU length of stay.
  • To identify FO as a predictor of mortality in pediatric intensive care.

Main Methods:

  • Prospective observational study of 230 children (1 month to 13 years) in a tertiary care hospital PICU.
  • Recorded demographic and clinical data, including fluid balance and PRISM-III scores.
  • Calculated cumulative FO and analyzed its association with outcomes using logistic regression and ROC analysis.

Main Results:

  • Median cumulative FO at 24 hours was 5.4%.
  • Non-survivors had significantly higher PRISM-III scores and FO percentages (p < 0.01).
  • ROC analysis indicated FO (AUC=0.72) and PRISM-III (AUC=0.97) as strong mortality predictors; 24-hour FO independently predicted mortality.

Conclusions:

  • Twenty-four-hour cumulative FO is a significant determinant of mortality in critically ill children.
  • Early monitoring and targeted management of FO are essential in PICUs.
  • Findings highlight the importance of fluid management strategies in pediatric intensive care.

Keywords:
critical illnesscumulative fluid balancefluid overloadlength of staymortalitypediatric intensive care unitprism iii score

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