Rao Sangeetha B, Akhondi-Asl Alireza, Mehta Nilesh, Yang Youyang
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
Perioperative and Critical Care Center for Outcomes Research and Evaluation (PC-CORE), Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Pediatr Res. 2025 Jun 25. doi: 10.1038/s41390-025-04218-3.
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.
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.
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).
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.
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.
急性危重病期间的液体超负荷（FO）可能会影响预后。本研究旨在描述儿科医学重症监护病房（MSICU）入院48小时后累积FO的发生率和影响因素，并评估其与临床预后的关联。
对2017年至2022年期间入住一家学术性四级儿童医院MSICU且重症监护病房（ICU）住院时间>48小时的所有0至18岁儿童进行了一项回顾性观察队列研究。评估了48小时时的FO百分比、与FO相关的液体成分，并将其与临床预后进行关联分析。
在3013例患者中，19%患有严重FO（>10%）。患有严重FO的患者年龄较小。与中度（5-10%）和轻度（<5%）FO组相比，严重FO组的维持静脉输液量最高（分别为122.0、104.0和74.0 mL/kg，P<0.001）。所有组在48小时时的总液体摄入量均超过了估计需求量。在对混杂因素进行调整后，中度和重度FO与ICU住院时间延长相关（风险比[RR]分别为1.22和1.2
