Fluid overload in critically ill children
In a critically ill patient, fluid balance is imperative in management and maintaining homeostasis. More often than not, patients are resuscitated with fluids to maintain adequate intravascular volume. A common issue seen in pediatric intensive care units is fluid imbalances and hemodynamic instability. Aggressive fluid administration can lead to fluid overload (FO), a condition in which there is a positive fluid balance in the patient. This phenomenon has been associated with a multitude of unfavorable effects and can further complicate the patient’s condition. While FO itself is no indicator of mortality, the adverse effects of FO on an already at risk population puts them at an increased risk of morbidity and mortality. Research on this commonly practiced standard of care has shown that inundation is not always the best method for hemodynamic optimization. Current literature shows that there is a lack of a standard definition of fluid overload and a standard guideline by which to direct fluid therapy. The purpose of this study was to review the literature highlighting the impact of FO on a multitude of outcomes in critically-ill children, analyzing the causative vs. associative relationship of FO with critical illness, and addressing the current pediatric fluid management guidelines.