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

BACKGROUND

Fluid overload (FO) during acute critical illness may affect outcomes. This study aimed to describe the incidence and contributors to cumulative FO 48 hours after pediatric MSICU admission and assess its association with clinical outcomes.

METHODS

A Retrospective observational cohort study was conducted of all Children 0-18 years old admitted from 2017-2022 with ICU stays >48 hours in the MSICU in an academic quaternary children's hospital. FO percentages, composition of fluid associated with FO at 48 hours was assessed and correlated with clinical outcomes.

RESULTS

Of 3013 patients, 19% had severe FO (>10%). Patients with severe FO were younger. Maintenance IVF was highest in severe FO compared to moderate (5-10%) and mild (<5%) FO groups (122.0 vs. 104.0 vs. 74.0 mL/kg, P < 0.001). Total fluid intake at 48 hours exceeded estimated requirements across all groups. After adjusting for confounders, moderate and severe FO were associated with increased ICU length of stay (RR 1.22, RR 1.25, P < 0.001). Severe FO also increased acute kidney injury (AKI) odds (OR = 1.43, P = 0.016) and reduced ventilator-free days at day 28 (VFD28) (OR = 0.58, P < 0.001).

CONCLUSION

Severe FO at 48 hours was linked to increased ICU LOS, AKI incidence, and fewer VFD28. FO is driven by multiple modifiable subtypes, especially after the first 24 hours. Further studies should explore interventions to reduce FO and improve outcomes.

IMPACT: Early FO at 48 h remains a prevalent problem in a mixed medical-surgical ICU and is linked to worse clinical outcomes. Severe FO was associated with younger age, lower body weight, and severity of illness in our cohort. The median total fluid intake at 48 h exceeded the estimated requirements in patients with any FO. We have identified specific fluid types that may be amenable to intervention to mitigate FO.