Fluid management and active fluid removal practices: a global survey of paediatric critical care physicians

Angela Aramburo, Sainath Raman, Jonathan A. Silversides, Luregn J. Schlapbach, Kristen S. Gibbons, Padmanabhan Ramnarayan, Breanna Pellegrini, Shane George, Corrine Balit, Felix Oberender, Simon Erickson, Jenipher Chumbes Flores, Karina Charles, Michaela Waak, Debbie Long, Warwick Butt, Carmel Delzoppo, Ben Gelbart, Kate Masterson, Johnny MillarAnusha Ganeshalingam, Claire Sherring, Puneet Singh, Vicky Smith, Jessica Schults, Jennifer Darvas, Marino Festa, The Australian, New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG), the United Kingdom Paediatric Critical Care Society Study Group (PCCS-SG)

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Abstract

Aims
Fluid accumulation (FA) in critically ill children is associated with poor clinical outcomes. While conservative fluid management has been proposed, evidence to guide practice is scarce. We surveyed paediatric critical care (PCC) physicians worldwide regarding their perceptions of FA, active fluid removal (AFR) practices, safety parameters, and willingness to participate in a clinical trial on the topic.

Methods
Cross-sectional international electronic survey of PCC physicians, distributed through research networks worldwide.

Results
A total of 409 PCC physicians from 48 countries participated in the survey; 40% (164/409) cared for cardiac patients. The majority believed FA was a modifiable source of morbidity (88%, 359/407) and expressed support for a trial on conservative fluid management trial (94%, 383/407). Restriction of maintenance fluid was more commonly practiced (87%, 335/387) than resuscitation fluid (54%, 210/387), with variability observed among individuals and patient categories. AFR was widely practiced (93%, 361/387), yet significant differences existed in patient selection, timing, modality, and rate. The most common reported time for starting AFR was 48 h (49%, 172/384), with most respondents (92%, 355/385) comfortable doing so in the setting of catecholamine infusions. While most respondents would continue diuretics with mild electrolyte or acid–base disturbances, 52% (179/342) would withhold them in cases of mild hypotension.

Conclusions
Fluid accumulation remains a significant concern among paediatric intensivists. The observed practice variability underscores the challenges in establishing evidence-based guidelines. Our survey highlights an urgent need for randomized trials in this field and provides valuable insights to inform the design of such future studies.
Original languageEnglish
Article number16
Number of pages10
JournalIntensive Care Medicine – Paediatric and Neonatal
Volume2
DOIs
Publication statusPublished - 16 Apr 2024

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