Aayush Khanal, MD
Critical Care Fellow
Washington University In St. Louis School Of Medicine, United States
Disclosure information not submitted.
Tara Neumayr, MD
Assistant Professor, Critical Care and Nephrology
Washington University In St. Louis School Of Medicine, United States
Disclosure information not submitted.
Matthew Goldsmith, MD
Professor, Critical Care Medicine
Washington University In St. Louis School Of Medicine, United States
Disclosure information not submitted.
Eileen Ciccia, MD
Assistant Professor
Washington University In St. Louis School Of Medicine, United States
Disclosure information not submitted.
Michael Wallendorf
Research Statistician
Washington University In St. Louis School Of Medicine, United States
Disclosure information not submitted.
John Lin, MD
Program Director, PCCM Fellowship
Washington University School of Medicine
Saint Louis, MO
Disclosure information not submitted.
Title: Fluid Overload in Pediatric Sepsis
Introduction: Fluid overload (FO) is a common entity in critically ill children with sepsis and is associated with substantial morbidity and mortality. Specific therapeutic fluid categories that contribute to the development of FO in pediatric sepsis have not been previously reported.
Methods: We conducted a prospective observational study in a tertiary-level academic pediatric intensive care unit (PICU) over 1 year. The primary aim of our study was to evaluate how particular categories of fluid intake contribute to the development of FO in pediatric sepsis. Secondary aims were to evaluate the incidence of FO, peak FO, time to peak FO and how FO impacts morbidity and mortality. We utilized the pediatric sequential organ dysfunction score (p-SOFA) to identify pediatric sepsis. Children with sepsis were prospectively observed for outcomes for the first 7 days of PICU stay. FO was defined as 10% increase in body weight or total cumulative fluid balance. Specific fluid categories were categorized as: enteral, maintenance, total parenteral nutrition, fluid bolus, blood and blood products, medicines, carrier fluids.
Results: We screened a total of 1057 children admitted to the PICU during the study period, of which 57 children met the p-SOFA criteria for sepsis (5.4% of all admissions). Our pediatric sepsis cohort comprised of equal number of males and females (n=29 females; 51%), with an average age of 9.4 years (± 7.1). Fifty-four percent (n=31) of children presented with septic shock and 73% presented with acute kidney injury (KDIGO Stage I or greater). Average FO incurred in our population was 9.7 % (± 5.5) (mean ± SD), with 82% (n=47) developing peak % FO in the first 3 days of ICU admission. Major contributors to total fluid intake were maintenance fluids (31.2%), medicines (16.8%), fluid bolus therapy (9.7%) and carrier fluids (8.1%). Forty percent (n=23) of children required mechanical ventilator support, 19.2% (n=11) required extracorporeal membrane oxygenation (ECMO) and 15% (n=9) required continuous renal replacement therapy (CRRT).
Conclusion: We have highlighted the specific contributors to the development of FO in pediatric sepsis. We hope this data will help us design and implement strategies to improve outcomes in pediatric sepsis with FO.