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Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children.
Denise C Hasson1, Ami Shah1, Chloe G Braun2
1Dept of Pediatrics, Hassenfeld Children's Hospital at NYU Langone Health, NY, NY.
Journal of Intensive Care Medicine
|July 16, 2025
Summary
Fluid overload is common in pediatric intensive care units (PICUs). Understanding site-specific fluid balance (FB) drivers and barriers is crucial for improving patient management and outcomes.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Fluid Balance Management
Background:
- Fluid overload (FO) is a significant issue in Pediatric Intensive Care Units (PICUs), linked to increased morbidity and mortality.
- Accurate fluid balance (FB) reporting and management are challenging due to varying needs and limitations across different PICUs.
Purpose of the Study:
- To investigate the prevalence of cumulative fluid balance (CFB) exceeding 5% and 10% on ICU days 1 and 2.
- To identify site-specific drivers of positive FB, barriers to accurate FB recording, and opportunities for improvement.
Main Methods:
- A concurrent mixed methods study using retrospective and prospective designs across four tertiary pediatric ICUs.
- Extracted FB data from electronic health records and utilized a federated data collection framework.
- Analyzed %CFB on ICU days 1 and 2, comparing results across sites using statistical tests.
Main Results:
- Day 2 CFB >5% ranged from 39% to 54% and >10% from 16% to 25% across sites.
- Significant inter-site variations observed in urine recording and fluid administration on Day 1.
- Common barriers to accurate FB reporting included issues with patient/family reporting and standardized charting.
Conclusions:
- High %CFB is prevalent in pediatric ICUs, with significant variation across institutions.
- Targeting individual ICU-specific drivers of FO is essential for effective fluid balance management.
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