Fluid Overload in Pediatric Severe Trauma

Abstract

Background and objective: Trauma is a leading cause of pediatric mortality and potential years of life lost in the developed world. Critically ill children frequently achieve a net positive fluid balance and fluid overload is associated with substantial morbidity and mortality in pediatrics. This study investigated the association between fluid balance status and clinical outcomes in pediatric severe trauma patients. Methods: This is a unicentric, observational retrospective study. Sixty-six children with severe trauma admitted to a tertiary hospital PICU over a 3-year period were included. Electronic medical records were reviewed. Fluid balance in the first 24 hours of PICU admission was calculated. Results: Males comprised 56% of the sample and median age was 12.2 years. Forty-one (62,1%) suffered polytrauma, 32 of these with traumatic brain injury (TBI), and 25 had isolated TBI. Seventeen (25,7%) patients had early fluid overload (FO). Early FO was not significantly associated with mortality, acute kidney injury, PICU length-of-stay, duration of mechanical ventilation and vasoactive support. TBI and polytrauma patients did not have increased risk of neither of these outcomes. Conclusions: Unlike other ICU cohorts, fluid overload does not appear to be associated with worse clinical outcomes in severe trauma patients.