Fluid overload in a South African pediatric intensive care unit

Objective: Fluid resuscitation is integral to resuscitation guidelines and critical care. However, fluid overload (FO) yields increased morbidity. Methods: Prospective observational study of Red Cross War Memorial Children's Hospital pediatric intensive care unit admissions (February to March 2013). FO %=(fluid in minus fluid out) [liters]/weight [kg]×100%. Primary outcomes: FO≥10%, 28 day mortality. Results: Median [interquartile range (IQR)] age: 9.5 (2.0-39.0) months, median (IQR) admission weight: 7.9 (3.6-13.7) kg. Median (IQR) FO with admission weight: 3.5 (2.1-4.9)%; three patients had FO≥10%. The 28 day mortality was 10% (n=10). Patients who died had higher mean (IQR) FO using admission weight [4.9 (2.9-9.3)% vs. 3.4 (1.9-4.8)%; p=0.04]. Conclusions: Low FO≥10% prevalence with 28 day mortality 10%. Higher FO% with admission weight associated with mortality (p=0.04). We advocate further investigation of FO% as a simple bedside tool.

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