Identifying Opportunities for Fluid Balance Optimization in Critically Ill Children.

This article focuses on the prevalence and management of fluid overload (FO), defined as pathologic positive cumulative fluid balance (%CFB), in pediatric intensive care units (PICUs) across four tertiary centers. The study found that %CFB greater than 5% and 10% within the first two ICU days is common but varies significantly between sites, with differences in fluid prescribing practices and accuracy of fluid balance (FB) recording. Barriers to accurate FB measurement—such as incomplete urine/stool collection and inconsistent documentation of fluid flushes—were similar across sites, while opportunities for improvement included standardizing charting and setting fluid balance goals during rounds, which currently occur infrequently. The findings highlight the need for site-specific strategies to enhance FB management and reduce FO, which is associated with increased morbidity, mortality, and ICU length of stay in critically ill children.