A recent systematic review found that in critically ill pediatric patients, a 1% increase in fluid accumulation is associated with a 6% increase in mortality risk.
Published in EClinicalMedicine, the meta-analysis assessed the association between fluid accumulation (FA) and clinical outcomes in critically ill children. By focusing on FA's impact within pediatric intensive care units (PICUs), this study aimed to provide updated evidence crucial for optimizing patient care.
The investigators conducted a comprehensive search of PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases from inception to May 2024, identifying relevant studies using terms related to critically ill children and fluid management. The inclusion criteria specified studies that assessed the effect of FA on mortality, mechanical ventilation duration, intensive care unit length of stay, and acute kidney injury. The primary outcome was all-cause mortality. This systematic review was registered with PROSPERO (CRD42023432879).
The meta-analysis included 120 studies encompassing a total of 44,682 pediatric patients. A significant association was found between FA and increased mortality (odds ratio [OR], 4.36; 95% confidence interval [CI], 3.53-5.38), acute kidney injury (OR, 1.98; 95% CI, 1.60-2.44), prolonged mechanical ventilation (weighted mean difference [WMD], 38.1 hours; 95% CI, 19.35-56.84), and extended PICU stays (WMD, 2.29 days; 95% CI, 1.19-3.38). Survivors exhibited a lower percentage of FA compared to non-survivors (WMD, -4.95; 95% CI, -6.03 to -3.87).
Methods employed during the analysis included pooling data using random-effects models to account for variations across studies. Sensitivity analyses were also performed to evaluate the robustness of the findings, particularly in studies that controlled for potential confounders. The analysis revealed that each 1% increase in FA was associated with a 6% increase in the odds of mortality (adjusted OR, 1.06; 95% CI, 1.04-1.09).
Within the review, it was also noted in 57 studies, mortality was evaluated by categorizing FA as a dichotomous exposure, employing 35 distinct FA definitions, and covering a total of 69,155 cases. “Our findings underscore the urgent need to standardize diagnostic criteria for fluid accumulation in pediatric population,” they stated.
It was also emphasized that future studies should consider potential confounding variables such as age, comorbidities, specific pathologies, and the phase and severity of the disease, and should also evaluate the impact of fluid type and the amount of non-resuscitation fluid exceeding hydration requirements on clinical outcomes.
“Despite the harm of FA, the effectiveness of restrictive fluid therapies or active fluid removal strategies (deresuscitation) is still debated,” noted investigators.
Authors reported no conflicts of interest.
