Fluid overload in critically ill children: A narrative review

Fluid overload (FO) is a common and challenging complication encountered among critically ill children admitted to pediatric intensive care unit (PICU), posing significant risks for morbidity and mortality. The pathophysiology of FO involves disruptions in fluid balance, exacerbated by underlying medical conditions, critical illness, and therapeutic interventions. Assessment of fluid status relies on a combination of clinical evaluation, laboratory tests, and imaging studies, with a focus on early detection and intervention to prevent complications. Management strategies for FO in the PICU encompass both preventive and therapeutic approaches. Prevention involves judicious fluid resuscitation, dynamic fluid assessment, advanced hemodynamic monitoring, careful monitoring of fluid input and output, early recognition of at-risk patients, and individualized approach. Therapeutic interventions may include diuretic therapy, optimization of hemodynamic support, and renal replacement therapy tailored to individual patient needs. Challenges in managing FO in PICU include balancing the need for adequate tissue perfusion with the risk of exacerbating FO and preventing complications such as electrolyte disturbances and organ dysfunction. Multidisciplinary collaboration, evidence-based practices, and continuous monitoring are essential for successful fluid management in critically ill children. This review aims to provide a comprehensive overview of the current understanding and management strategies for FO among critically ill children.