Association Between Early Fluid Overload and Mortality in Critically Ill Children
Introduction: Fluid therapy is essential during the resuscitation of critically ill children. However, aggressive resuscitation and additional fluids from medications and nutritional support often lead to fluid accumulation. Emerging evidence indicates that fluid buildup may negatively affect outcom...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Galenos Publishing House
2025-08-01
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| Series: | Journal of Pediatric Emergency and Intensive Care Medicine |
| Subjects: | |
| Online Access: | https://www.caybdergi.com/articles/association-between-early-fluid-overload-and-mortality-in-critically-ill-children/doi/cayd.galenos.2025.59354 |
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| Summary: | Introduction: Fluid therapy is essential during the resuscitation of critically ill children. However, aggressive resuscitation and additional fluids from medications and nutritional support often lead to fluid accumulation. Emerging evidence indicates that fluid buildup may negatively affect outcomes. This study aims to evaluate the relationship between early fluid accumulation and mortality in critically ill children.
Methods: This study enrolled 74 children in the pediatric intensive care unit (PICU) at Adam Malik, excluding those with prior renal impairment or a stay of less than 24 hours. Patients were categorized into survivors and non-survivors. Early fluid accumulation was calculated from the first 24 hours of fluid intake and output after admission.
Results: Out of 74 patients, 55.4% of whom were boys, with a median age of 31 months [interquartile range (IQR) 8-118 months]. The median first 24-hour fluid accumulation was 1.92% (IQR -48% to 20%). Fluid accumulation differed significantly between survivors and non-survivors (p=0.001), with non-survivors showing higher fluid accumulation (16%, IQR -10% to 27%) compared to survivors (-4%, IQR -20% to 4%). Bivariate analysis shows that fluid accumulation, vasoactive agent, mechanical ventilation, and pediatric logistic organ dysfunction-2 score have significant association with mortality (p<0.05). Multivariate analysis indicates that early fluid accumulation is linked to higher mortality [odds ratio (OR): 1.64; 95% confidence interval (CI): 1.22-2.19; p=0.001], while vasoactive agents are protective factors (OR: 0.28; 95% CI: 0.09-0.94).
Conclusion: Fluid accumulation is common in the PICU and significantly linked to mortality. These findings underscore the need to develop and evaluate strategies to mitigate the harmful effects of fluid accumulation. |
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| ISSN: | 2146-2399 2148-7332 |