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Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep
BACKGROUND: Fluid therapy is a cornerstone of pediatric intensive care medicine. We aimed at quantifying the load of water, sodium and chloride due to different fluid indications in our pediatric intensive care unit (PICU). We were particularly interested in the role of fluid creep, i.e. fluid admin...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487923/ https://www.ncbi.nlm.nih.gov/pubmed/32891127 http://dx.doi.org/10.1186/s12887-020-02322-3 |
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author | Langer, Thomas D’Oria, Veronica Spolidoro, Giulia C. I. Chidini, Giovanna Scalia Catenacci, Stefano Marchesi, Tiziana Guerrini, Marta Cislaghi, Andrea Agostoni, Carlo Pesenti, Antonio Calderini, Edoardo |
author_facet | Langer, Thomas D’Oria, Veronica Spolidoro, Giulia C. I. Chidini, Giovanna Scalia Catenacci, Stefano Marchesi, Tiziana Guerrini, Marta Cislaghi, Andrea Agostoni, Carlo Pesenti, Antonio Calderini, Edoardo |
author_sort | Langer, Thomas |
collection | PubMed |
description | BACKGROUND: Fluid therapy is a cornerstone of pediatric intensive care medicine. We aimed at quantifying the load of water, sodium and chloride due to different fluid indications in our pediatric intensive care unit (PICU). We were particularly interested in the role of fluid creep, i.e. fluid administered mainly as the vehicle for drugs, and the association between sodium load and water balance. METHODS: Critically ill children aged ≤3 years and invasively ventilated for ≥48 h between 2016 and 2019 in a single tertiary center PICU were retrospectively enrolled. Need for renal replacement therapy, plasmapheresis or parenteral nutrition constituted exclusion criteria. Quantity, quality and indication of fluids administered intravenously or enterally, urinary output and fluid balance were recorded for the first 48 h following intubation. Concentrations of sodium and chloride provided by the manufacturers were used to compute the electrolyte load. RESULTS: Forty-three patients (median 7 months (IQR 3–15)) were enrolled. Patients received 1004 ± 284 ml of water daily (153 ± 36 ml/kg/day), mainly due to enteral (39%), creep (34%) and maintenance (24%) fluids. Patients received 14.4 ± 4.8 mEq/kg/day of sodium and 13.6 ± 4.7 mEq/kg/day of chloride, respectively. The majority of sodium and chloride derived from fluid creep (56 and 58%). Daily fluid balance was 417 ± 221 ml (64 ± 30 ml/kg/day) and was associated with total sodium intake (r(2) = 0.49, p < 0.001). CONCLUSIONS: Critically ill children are exposed, especially in the acute phase, to extremely high loads of water, sodium and chloride, possibly contributing to edema development. Fluid creep is quantitatively the most relevant fluid in the PICU and future research efforts should address this topic in order to reduce the inadvertent water and electrolyte burden and improve the quality of care of critically ill children. |
format | Online Article Text |
id | pubmed-7487923 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74879232020-09-16 Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep Langer, Thomas D’Oria, Veronica Spolidoro, Giulia C. I. Chidini, Giovanna Scalia Catenacci, Stefano Marchesi, Tiziana Guerrini, Marta Cislaghi, Andrea Agostoni, Carlo Pesenti, Antonio Calderini, Edoardo BMC Pediatr Research Article BACKGROUND: Fluid therapy is a cornerstone of pediatric intensive care medicine. We aimed at quantifying the load of water, sodium and chloride due to different fluid indications in our pediatric intensive care unit (PICU). We were particularly interested in the role of fluid creep, i.e. fluid administered mainly as the vehicle for drugs, and the association between sodium load and water balance. METHODS: Critically ill children aged ≤3 years and invasively ventilated for ≥48 h between 2016 and 2019 in a single tertiary center PICU were retrospectively enrolled. Need for renal replacement therapy, plasmapheresis or parenteral nutrition constituted exclusion criteria. Quantity, quality and indication of fluids administered intravenously or enterally, urinary output and fluid balance were recorded for the first 48 h following intubation. Concentrations of sodium and chloride provided by the manufacturers were used to compute the electrolyte load. RESULTS: Forty-three patients (median 7 months (IQR 3–15)) were enrolled. Patients received 1004 ± 284 ml of water daily (153 ± 36 ml/kg/day), mainly due to enteral (39%), creep (34%) and maintenance (24%) fluids. Patients received 14.4 ± 4.8 mEq/kg/day of sodium and 13.6 ± 4.7 mEq/kg/day of chloride, respectively. The majority of sodium and chloride derived from fluid creep (56 and 58%). Daily fluid balance was 417 ± 221 ml (64 ± 30 ml/kg/day) and was associated with total sodium intake (r(2) = 0.49, p < 0.001). CONCLUSIONS: Critically ill children are exposed, especially in the acute phase, to extremely high loads of water, sodium and chloride, possibly contributing to edema development. Fluid creep is quantitatively the most relevant fluid in the PICU and future research efforts should address this topic in order to reduce the inadvertent water and electrolyte burden and improve the quality of care of critically ill children. BioMed Central 2020-09-05 /pmc/articles/PMC7487923/ /pubmed/32891127 http://dx.doi.org/10.1186/s12887-020-02322-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Langer, Thomas D’Oria, Veronica Spolidoro, Giulia C. I. Chidini, Giovanna Scalia Catenacci, Stefano Marchesi, Tiziana Guerrini, Marta Cislaghi, Andrea Agostoni, Carlo Pesenti, Antonio Calderini, Edoardo Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
title | Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
title_full | Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
title_fullStr | Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
title_full_unstemmed | Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
title_short | Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
title_sort | fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487923/ https://www.ncbi.nlm.nih.gov/pubmed/32891127 http://dx.doi.org/10.1186/s12887-020-02322-3 |
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