Stephen Gorga, MD, MSc
Assistant Professor of Pediatrics
CS Mott Childrens Hospital at University of Michigan, United States
Disclosure information not submitted.
Title: CLINICIAN AWARENESS OF FLUID ADMINISTRATION AMONG CRITICALLY ILL CHILDREN
Introduction: Over 1/3 of Pediatric Intensive Care Unit (PICU) patients will become fluid overloaded and over ½ receive more fluids than hydration needs, increasing mortality and patient harm. While intravenous (IV) fluids are necessary for many therapies, administration of these fluids is a potentially modifiable risk factor for fluid overload. Currently, clinician awareness regarding IV fluid administration is unknown. Our study investigates clinician recognition of the volume of IV fluids that patients will receive over the next day.
Methods: PICU clinicians (Bedside Nurses, Attendings, Fellows, Residents, and Nurse Practitioners (NPs)) were approached and were eligible to participate if they cared for a patient in the PICU and were asked after rounds to estimate the total volume of IV fluid that their patient would receive over the next day. Surveys were administered after team rounds to ensure that team decision making had occurred on that day. Chart reviews performed after 24 hours collected demographics and volume of IV fluids received. Patients were excluded if they were discharged < 24 hours post-survey. Clinician estimates were then compared to actual IV fluid volume given and reported in the absolute value of weight adjusted milliliters of fluid per kilogram (ml/kg) of patient weight.
Results: Over survey 28 days between May 5, 2021 to June 30, 2021, 1150 surveys were administered to 132 unique people about 168 unique patients. Patients’ median [Interquartile Range (IQR)] age was 5.2 years [1.0-13.6] admitted for mostly pulmonary (32.7%) reasons with 50.6% on mechanical ventilation and 8.9% on vasoactives on the survey day. Among all surveys, the median difference between fluid estimates and reality was 9.6 [1.5-26.4] ml/kg. Recognition was significantly different between roles in the PICU: Bedside Nurses were most accurate (difference of 3.6 [0.2-15.8] ml/kg) and Attendings were least accurate (difference 17.4 [5.5-38.9] ml/kg (p < 0.001 by Kruskall-Wallis)).
Conclusion: PICU clinicians are unaware of how much IV fluid patients receive, with a median difference similar to a typical IV fluid bolus for resuscitation. Significant differences in accuracy exist between clinical roles in the PICU. Investigations into the impact of improved recognition of fluid exposure are warranted.