Management of Fluid Overload in the Pediatric ICU

Ker, Grace; Gangadharan, Sandeep

doi:10.1007/978-3-319-96499-7_11

Cited by 3 publications

(2 citation statements)

References 51 publications

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“…Finally, renal perfusion may be compromised, especially under stressful situations, leading to the development of acute kidney injury, which makes it more difficult for the kidneys to maintain euvolemia. 17 Hayes described in his study that in children with end-stage kidney disease, dysregulation of intravascular fluid volume leads to cardiovascular morbidity and eventually mortality. The most frequent cause of death in children receiving dialysis is cardiovascular problems.…”

Section: Evidence From Literature For Adverse Effects Of Fluid Overloadmentioning

confidence: 99%

Adverse effects of fluid overload in different paediatric age groups

Althagafi¹,

Qartali²,

Alasmari

et al. 2022

Int J Community Med Public Health

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Fluid resuscitation is a routine procedure in the treatment of critically ill patients especially in paediatric intensive care units. Fluid overload can result from instability in fluid homeostasis caused by the administration of excessive fluids. Fluid overload can have a wide range of adverse impacts on paediatric critical care patients, including increased mortality risk. Fluid overload increases the length of hospital stay and ventilation time also elevates requirement for renal replacement treatment. The purpose of this research is to review the available information about adverse effects of fluid overload in different paediatric age groups. Literature suggests that fluid overload is associated with significant morbidity and mortality among children. Fluid overload percentage greater than 10% is linked to higher mortality rates among children. Respiratory failure can be triggered by pulmonary alveolar and interstitial edema caused by hypervolemia. Children suffering from acute kidney injury or other renal diseases experience more worsened conditions in presence of fluid overload. Fluid overload can impair organ performance, which can impact disease and fatality. Excessive fluid may alter the efficiency of the heart and perhaps impair cardiac function by considerably moving ventricular compliance to the right on the Frank-Starling curve. The negative effects of fluid overload make patients more susceptible to an elevated risk of morbidity and death even if fluid overload itself is not a direct indicator of mortality. Further research can in aid in developing preventive and management strategies for the fluid balance in paediatric settings.

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Section: Evidence From Literature For Adverse Effects Of Fluid Overloadmentioning

confidence: 99%

Adverse effects of fluid overload in different paediatric age groups

Althagafi¹,

Qartali²,

Alasmari

et al. 2022

Int J Community Med Public Health

View full text Add to dashboard Cite

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“…29 Ethacrynic acid is a non-sulfonamide loop diuretic that is less commonly used due to concern for increased ototoxicity and cost. 30,31 The loop diuretics furosemide and ethacrynic acid are labelled for use as diuretics in paediatric populations: Intravenous and oral furosemide are labelled by the Food and Drug Administration for the treatment of oedema in paediatric patients of all ages with congestive heart failure, hepatic cirrhosis, and renal disease, 32 and oral ethacrynic acid is Food and Drug Administration-labelled for the short-term management of oedema in hospitalised paediatric patients with CHD or nephrotic syndrome. 33 Notably, both intravenous and oral ethacrynic acid are contraindicated for use in infants by Food and Drug Administration labelling.…”

Section: Loop Diureticsmentioning

confidence: 99%

A systematic review of the evidence supporting post-operative diuretic use following cardiopulmonary bypass in children with Congenital Heart Disease

et al. 2021

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Background: Paediatric cardiac surgery on cardiopulmonary bypass induces substantial physiologic changes that contribute to post-operative morbidity and mortality. Fluid overload and oedema are prevalent complications, routinely treated with diuretics. The optimal diuretic choice, timing of initiation, dose, and interval remain largely unknown. Methods: To guide clinical practice and future studies, we used PubMed and EMBASE to systematically review the existing literature of clinical trials involving diuretics following cardiac surgery from 2000 to 2020 in children aged 0–18 years. Studies were assessed by two reviewers to ensure that they met eligibility criteria. Results: We identified nine studies of 430 children across four medication classes. Five studies were retrospective, and four were prospective, two of which included randomisation. All were single centre. There were five primary endpoints – urine output, acute kidney injury, fluid balance, change in serum bicarbonate level, and required dose of diuretic. Included studies showed early post-operative diuretic resistance, suggesting higher initial doses. Two studies of ethacrynic acid showed increased urine output and lower diuretic requirement compared to furosemide. Children receiving peritoneal dialysis were less likely to develop fluid overload than those receiving furosemide. Chlorothiazide, acetazolamide, and tolvaptan demonstrated potential benefit as adjuncts to traditional diuretic regimens. Conclusions: Early diuretic resistance is seen in children following cardiopulmonary bypass. Ethacrynic acid appears superior to furosemide. Adjunct diuretic therapies may provide additional benefit. Study populations were heterogeneous and endpoints varied. Standardised, validated endpoints and pragmatic trial designs may allow investigators to determine the optimal diuretic, timing of initiation, dose, and interval to improve post-operative outcomes.

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