Fluid Accumulation Dilemma in the Critically Ill Children, A Retrospective Study

Abstract

Aim: Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medications administered in pediatric intensive care units can contribute to significant cumulative load in patients. In present study, we aimed to study fluid accumulation on patients without AKI and to determine contribution of medications over fluid intake. Material and Method: In this study, 527 daily follow-up forms of 101 patients was investigated retrospectively. Results: Total fluid load was found to be higher in patients with comorbidities, who underwent invasive mechanical ventilation, and who needed inotropes. While fluid load was higher in patients with sepsis than in other diagnostic groups, it was significantly lower in patients with multisystem inflammatory syndrome in children (MIS-C). While the median (IQR) of the cumulative fluid load was 11.6% (7.1-16.4) in the first 5 days, the median (IQR) reached 25.7% (14.65-34.1) on the 10th day. The cumulative fluid load increased as the patient's follow-up days increased. The median average daily fluid intake (IQR) from drugs alone was 14.48% (8.07-24.13). The contribution of drugs to the total fluid load increased as the age of patients decreased (r: -0.164, p< 0.001). Conclusion: A cumulative fluid load occurs in PICU patients without AKI. Particularly in young children, the contribution of fluids given with drugs to the fluid load should be kept in mind. Clinicians should perform patient-specific fluid management by supporting fluid status assessments with objective criteria in order to get out of the fluid accumulation- fluid over load dilemma.

Keywords

• çocuk yoğun bakım
• sıvı birikimi
• sıvı yükü
• ilaç
• pediatric intensive care
• fluid accumulation
• fluid load
• medication