Objectives: 

Fluid overload is common in the PICU and has been associated with increased morbidity and mortality. It remains unclear whether fluid overload is a surrogate marker for severity of illness and need for increased support, an iatrogenic modifiable risk factor, or a sign of oliguria. The proportions of various fluid intake contributing to fluid overload and its recognition have not been adequately examined. We aimed to: 1) describe the types and amounts of fluid exposure in the PICU and 2) identify the clinicians’ recognition of fluid overload.

Setting: 

Noncardiac PICU in a quaternary care hospital.

Patients: 

Pediatric patients admitted for more than 24 hours.

Design: 

Prospective observational study over 28 days.

Interventions: 

Data were collected on the amount and type of fluid exposure—resuscitative boluses, blood products, enteral intake, parenteral nutrition (total parenteral nutrition), or modifiable fluids (IV fluids and medications) indexed to the patients’ admission body surface area on days 1 and 3. Charts of patients admitted for 3 days who developed 15% fluid overload were reviewed to assess clinicians’ recognition of fluid overload.

Measurements and Main Results: 

One hundred two patients were included. Day 1 median fluid exposure was 2,318 mL/m² (1,831–3,037 mL/m²; 1,646 mL/m² [1,296–2,086 mL/m²] modifiable fluids). Forty-seven patients (46%) received fluid boluses, and 16 (16%) received blood products. Day 3 median fluid exposure was 2,233 mL/m² (1,904–2,556 mL/m²; 750 mL/m² [375–1,816 mL/m²] modifiable fluids). Of the 54 patients, one patient (1.9%) received a fluid bolus and two (3.7%) received blood products. In our cohort, 47 of 54 (87%) had fluid exposure greater than 1,600 mL/m² on day 3. Fluid overload was not recognized by the clinicians in 30% of the patients who developed more than 15% fluid overload.

Conclusions: 

Although resuscitation fluids contributed more to fluid exposure on day 1 compared with day 3, fluid exposure frequently exceeded maintenance requirements on day 3. Fluid overload was not always recognized by PICU practitioners. Further studies to correlate modifiable fluid exposure to fluid overload and explore modifiable practice improvement opportunities are needed.

中文翻译：

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危重儿童的液体暴露状况和对液体超负荷的认识。

目标： 

液体超负荷在PICU中很常见，并与发病率和死亡率增加有关。尚不清楚液体超负荷是否是疾病严重程度的替代标志，是否需要增加支持，医源性可改变的危险因素或少尿的迹象。尚未充分检查导致流体过载及其识别的各种流体摄入量的比例。我们旨在：1）描述PICU中液体暴露的类型和数量，以及2）确定临床医生对液体超负荷的认识。

设置： 

非心脏PICU在四级护理医院。

耐心： 

小儿患者入院时间超过24小时。

设计： 

为期28天的前瞻性观察研究。

干预措施： 

在第1天收集了关于液体暴露量和类型的数据-复苏性大剂量，血液制品，肠内摄入，肠胃外营养（总肠胃外营养）或可改变体液（静脉输液和药物）与患者入院体表的索引和3.回顾入院3天出现液体超负荷15％的患者图表，以评估临床医生对液体超负荷的认识。

测量和主要结果： 

包括102名患者。第1天的液体中位数暴露为2,318 mL / m ²（1,831–3,037 mL / m ²； 1,646 mL / m ² [1,296–2,086 mL / m ² ]可修正的液体）。四十七名患者（46％）接受了液体推注，十六名患者（16％）接受了血液制品。第3天的液体中位数暴露为2,233 mL / m ²（1,904–2,556 mL / m ²； 750 mL / m ² [375-1,816 mL / m ² ]可修正的液体）。在这54名患者中，一名患者（1.9％）接受了一次大剂量推注，两名患者（3.7％）接受了血液制品。在我们的队列，54（87％）47有流体曝光大于1600毫升/米²在第3天液体超负荷在30％的液体超负荷患者中，有30％的患者没有被临床医生认可。

结论： 

尽管与第3天相比，复苏液在第1天对液体暴露的贡献更大，但在第3天，液体暴露经常超过维护要求。PICU从业人员并不总是认识到液体过载。需要进行进一步的研究，以将可调节的液体暴露与液体超负荷相关联，并探索可调节的实践改进机会。