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Association between early fluid overload and clinical outcomes in a pediatric ICU

Sangeetha B Rao1,2, Alireza Akhondi-Asl3,4, Nilesh Mehta3,4

  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Department of Anaesthesia, Harvard Medical School, Boston, MA, USA. sangeetha.rao@childrens.harvard.edu.

Pediatric Research
|June 25, 2025
PubMed

Insights

Fluid overload (FO) in critically ill children admitted to the pediatric mixed medical-surgical ICU is common and linked to worse outcomes. Interventions targeting specific fluid types may reduce FO and improve patient results.

Area of Science:

  • Pediatric critical care medicine
  • Nephrology
  • Intensive care research

Background:

  • Fluid overload (FO) is a potential concern in critically ill children.
  • Understanding FO incidence and contributors is crucial for improving outcomes.

Purpose of the Study:

  • To determine the incidence and contributors to cumulative FO within 48 hours of pediatric ICU admission.
  • To assess the association between FO and clinical outcomes in this population.

Main Methods:

  • Retrospective observational cohort study of children (0-18 years) admitted to a pediatric MSICU (2017-2022).
  • Analysis of FO percentages and fluid composition at 48 hours.
  • Correlation of FO with clinical outcomes, including ICU length of stay, AKI, and ventilator-free days.

Main Results:

  • 19% of 3013 patients experienced severe FO (>10%).
  • Severe FO was associated with younger age and higher maintenance IV fluid administration.
  • Moderate and severe FO correlated with increased ICU length of stay, higher odds of acute kidney injury (AKI), and fewer ventilator-free days at day 28 (VFD28).

Conclusions:

  • Severe FO at 48 hours is prevalent in pediatric ICUs and associated with adverse clinical outcomes.
  • FO is influenced by multiple modifiable fluid subtypes, particularly after the initial 24 hours.
  • Further research into interventions to mitigate FO is warranted to improve patient outcomes.
Abstract

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