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The ROSE framework for fluid therapy in critically ill pediatric patients

Romina Aparecida Dos Santos Gomes1,2, Manu L N G Malbrain3,4,5, Adriana Teixeira Rodrigues1,2

  • 1Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

Anaesthesiology Intensive Therapy
|March 4, 2026
PubMed

Insights

The ROSE framework is applicable for pediatric fluid management, showing feasibility and potential for individualizing care. While fluid accumulation was similar, adherence improved post-training.

Area of Science:

  • Pediatric Critical Care Medicine
  • Fluid Management Strategies
  • Clinical Framework Implementation

Background:

  • Critically ill children often experience fluid overload, impacting outcomes.
  • The Resuscitation, Optimization, Stabilization, Evacuation (ROSE) framework offers a structured approach to fluid therapy.
  • Assessing the ROSE framework's applicability in pediatric intensive care is crucial.

Purpose of the Study:

  • To evaluate the feasibility and impact of the ROSE framework on fluid management in critically ill pediatric patients.
  • To assess the framework's effectiveness in preventing fluid accumulation and improving clinical outcomes.
  • To benchmark fluid accumulation percentages (FA%) across different phases of the ROSE framework.

Main Methods:

  • A quasi-experimental study comparing retrospective and prospective cohorts (n=122) of mechanically ventilated, vasoactive-dependent children.
  • Implementation of structured training on ROSE-guided fluid management for the prospective cohort.
  • Outcomes measured included fluid accumulation percentage (FA%), mechanical ventilation duration, PICU length of stay, and need for renal replacement therapy (RRT).

Main Results:

  • Fluid accumulation percentage (FA%) remained similar between retrospective and prospective cohorts across multiple time points.
  • FA% was comparable during Resuscitation, Optimization, and Evacuation phases, but higher during Stabilization in the prospective cohort.
  • Adherence to FA% targets increased from 67.9% to 72.4% after ROSE framework implementation; other clinical outcomes were similar.

Conclusions:

  • The ROSE framework is a feasible approach for managing fluid therapy in critically ill pediatric patients.
  • It provides valuable benchmarking for controlling fluid accumulation and shows promise for personalized fluid management.
  • Further validation in centers not previously exposed to the ROSE framework is recommended.
Abstract

Keywords:
ROSEchildrencritically illevacuationfluid accumulationfluid therapyoptimizationresuscitationstabilization

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