Hopwood Andrew J, Schade Willis Tina M, Starr Michelle C, Hughes Katie M, Malin Stefan W
From the Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind.
Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind.
Pediatr Qual Saf. 2025 May 1;10(3):e813. doi: 10.1097/pq9.0000000000000813. eCollection 2025 May-Jun.
Fluid overload, the pathologic state of positive fluid balance, is common in the pediatric intensive care unit (PICU) and is independently associated with poor outcomes. Quality improvement-based processes to measure and assess fluid balance in critically ill children are lacking.
The primary aim was to develop and implement a fluid management strategy that includes the standardized measurement and assessment of fluid balance, which is adhered to in at least 50% of all PICU patients. The 4 components of the strategy include (1) creating a fluid balance dashboard that tracks percent cumulative fluid balance over time, (2) documentation of daily weights, (3) fluid balance reporting and discussion incorporated into standardized rounds, and (4) active total intravenous (IV) fluid order.
We reviewed 280 patient encounters between May 2023 and April 2024 and achieved the primary aim of at least 50% compliance with the fluid management strategy and maintained this success over time. Achieving the primary aim coincides with implementing daily weights and total IV fluid orders into PICU admission order sets.
In this quality improvement project, we develop, implement, and maintain compliance with a fluid management strategy. Future work will involve daily utilization of the fluid balance dashboard and monitoring compliance with total IV fluid orders. Implementing a quality improvement-based fluid management strategy may lead to improved awareness of the fluid status of patients and the prescription of fluid therapy to mitigate the harmful effects of fluid overload.
液体超负荷是液体正平衡的病理状态，在儿科重症监护病房（PICU）中很常见，并且与不良预后独立相关。目前缺乏基于质量改进的方法来测量和评估危重症儿童的液体平衡。
主要目标是制定并实施一种液体管理策略，该策略包括对液体平衡进行标准化测量和评估，且至少50%的PICU患者都要遵循该策略。该策略的4个组成部分包括：（1）创建一个液体平衡仪表盘，跟踪随时间变化的累积液体平衡百分比；（2）记录每日体重；（3）将液体平衡报告和讨论纳入标准化查房；（4）主动下达总静脉（IV）液体医嘱。
我们回顾了2023年5月至2024年4月期间的280例患者诊疗情况，实现了至少50%的患者遵循液体管理策略这一主要目标，并长期保持了这一成果。实现主要目标与在PICU入院医嘱集中加入每日体重和总静脉液体医嘱相契合。
在这个质量改进项目中，我们制定、实施并维持了对液体管理策略的遵循。未来的工作将包括每天使用液体平衡仪表盘以及监测总静脉液体医嘱的遵循情况。实施基于质量改进的液体管理策略可能会提高对患者液体状态的认识，并优化液体治疗的处方，以减轻液体超负荷的有害影响。
