Mohoric Shannon, Alobaidi Rashid, McGraw Tegan, Joffe Ari R
Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children's Hospital, 4-546 Edmonton Clinic Health Academy; 11405 112 Street, Edmonton, AB, T6G 1C9, Canada.
Stollery Children's Hospital, Edmonton, AB, Canada.
Pediatr Nephrol. 2025 Jul 14. doi: 10.1007/s00467-025-06875-2.
Fluid accumulation (FA) is associated with morbidity and mortality in intensive care. We aimed to determine sources of FA in critically ill children admitted to pediatric intensive care.
Prospective cohort study of children in a university affiliated tertiary pediatric intensive care unit. Primary outcome was to describe contributors to fluid intake. Secondary outcomes were independent associations between fluid intake and FA > 5%, ventilator-free days, and intensive-care-free days.
Of patients admitted to intensive care, 99/120 (83%) met eligibility criteria. Median total fluid intake was median [interquartile range (IQR)] 46.9 [30.3, 72.1] ml/kg/day, and median [IQR] fluid output was 26.3 [15.1, 49.8] ml/kg/day. The largest contributors to fluid intake were maintenance (37.4%; IQR 20.0, 57.3), nutrition (23.2%; IQR 6.8, 58.1), medications (7.8%; IQR 2.9, 21.8), and resuscitative fluid (4.2%; IQR 0, 18). Children with peak FA > 5% versus FA ≤ 5% had higher total fluid intake (67.8 vs. 30.3 ml/kg/day; odds ratio (OR) 1.09 [95% confidence interval (CI), 1.06, 1.14)] and output [36.9 vs. 19.5 ml/kg/day; OR 1.04 (95% CI, 1.02, 1.06)], and higher volumes of maintenance, nutrition, and medications, but not resuscitative fluid. Total fluid intake was independently associated with FA > 5% (OR 1.09; 95% CI 1.05, 1.14; p < 0.001). At 28 days, peak FA% was independently associated with fewer intensive-care-free days [Effect Size - 0.30 (95% CI - 0.45, - 0.16), p < 0.001)].
Higher fluid intake, rather than reduced output, was the predominant factor in FA, with maintenance fluid being the largest source of intake. Future research should evaluate the impact of optimized maintenance fluid calculations.
液体潴留（FA）与重症监护中的发病率和死亡率相关。我们旨在确定入住儿科重症监护病房的危重症儿童的FA来源。
对一所大学附属三级儿科重症监护病房的儿童进行前瞻性队列研究。主要结局是描述液体摄入的影响因素。次要结局是液体摄入与FA>5%、无呼吸机天数和无重症监护天数之间的独立关联。
在入住重症监护病房的患者中，99/120（83%）符合纳入标准。液体总摄入量中位数[四分位间距（IQR）]为46.9[30.3，72.1]ml/（kg·天），液体总排出量中位数[IQR]为26.3[15.1，49.8]ml/（kg·天）。液体摄入的最大影响因素是维持量（37.4%；IQR 20.0，57.3）、营养（23.2%；IQR 6.8，58.1）、药物（7.8%；IQR 2.9，21.8）和复苏液体（4.2%；IQR 0，18）。FA峰值>5%的儿童与FA≤5%的儿童相比，液体总摄入量更高（67.8比30.3ml/（kg·天）；优势比（OR）1.09[95%置信区间（CI），1.06，1.14]）和排出量更高[36.9比19.5ml/（kg·天）；OR 1.04（95%CI，1.02，1.06）]，维持量、营养和药物的摄入量也更高，但复苏液体摄入量无差异。液体总摄入量与FA>5%独立相关（OR 1.09；95%CI 1.05，1.14；P<0.001）。在28天时，FA峰值百分比与无重症监护天数减少独立相关[效应量-0.30（95%CI-0.45，-0.16），P<0.001]。
液体摄入增加而非排出减少是FA的主要因素，维持液是摄入的最大来源。未来的研究应评估优化维持液计算的影响。
