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

• Pediatric intensive care
• fluid accumulation
• fluid load
• medication

Kritik Hasta Çocuklarda Sıvı Birikimi İkilemi, Retrospektif Bir Çalışma

Abstract

Amaç: Çocuk yoğun bakım ünitelerinde (ÇYBÜ) hastalarda sıvı birikimi meydana gelmektedir. Çocuk yoğun bakım ünitelerinde uygulanan ilaçlar, hastalarda önemli kümülatif sıvı yüküne katkıda bulunabilir. Bu çalışmada akut böbrek yetmezliği (AKI) olmayan hastalarda sıvı birikimini araştırmayı ve ilaçların sıvı alımına katkısını belirlemeyi amaçladık. Gereç ve Yöntem: Bu çalışmada 101 hastaya ait 527 adet günlük takip formu geriye dönük olarak incelendi. Bulgular: Komorbiditesi olan, invaziv mekanik ventilasyon uygulanan ve inotrop ihtiyacı olan hastalarda toplam sıvı yükü daha yüksek bulundu. Sepsisli hastalarda sıvı yükü diğer tanı gruplarına göre daha yüksek iken, çocuklarda multisistem inflamatuar sendromlu hastalarda (MIS-C) anlamlı olarak daha düşüktü. Kümülatif sıvı yükü medyan (IQR) ilk 5 günde %11,6 (7,1-16,4) iken 10. günde medyan (IQR) %25,7'ye (14,65-34,1) ulaştı. Hastanın takip günleri arttıkça kümülatif sıvı yükü arttı. Tek başına ilaçlardan ortalama günlük sıvı alımı (IQR) %14,48 (8,07-24,13) idi. İlaçların toplam sıvı yüküne katkısı hastaların yaşı azaldıkça arttı (r: -0,164, p< 0,001). Sonuç: AKI'si olmayan ÇYBÜ hastalarında kümülatif sıvı yükü oluşur. Özellikle küçük çocuklarda ilaçla birlikte verilen sıvıların sıvı yüküne katkısı akılda tutulmalıdır. Klinisyenler sıvı birikimi-sıvı aşırı yüklenmesi ikileminden kurtulmak için sıvı durum değerlendirmelerini objektif kriterlerle destekleyerek hastaya özel sıvı yönetimi yapmalıdır.

Keywords

• Çocuk yoğun bakım
• sıvı birikimi
• sıvı yükü
• ilaç

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