Balance de líquidos en el niño grave / Children, critical care and fluid balance

Pueblo Mágico. Información / Information Sobrecarga de líquidos en niños críticamente enfermos. Fluid Overload in Critically Ill Children. Raina R1,2, Sethi SK3, Wadhwani N3, Vemuganti M4, Krishnappa V2,5, Bansal SB3. Front Pediatr. 2018 Oct 29;6:306. doi: 10.3389/fped.2018.00306. eCollection 2018. Abstract Background: A common practice in the management of critically ill patients is fluid resuscitation. An excessive administration of fluids can lead to an imbalance in fluid homeostasis and cause fluid overload (FO). In pediatric critical care patients, FO can lead to a multitude of adverse effects and increased risk of morbidity. Objectives: To review the literature highlighting impact of FO on a multitude of outcomes in critically-ill children, causative vs. associative relationship of FO with critical illness and current pediatric fluid management guidelines. Data Sources: A literature search was conducted using PubMed/Medline and Embase databases from the earliest available date until June 2017. Data Extraction: Two authors independently reviewed the titles and abstracts of all articles which were assessed for inclusion. The manuscripts of studies deemed relevant to the objectives of this review were then retrieved and associated reference lists hand-searched. Data Synthesis: Articles were segregated into various categories namely pathophysiology and sequelae of fluid overload, assessment techniques, epidemiology and fluid management. Each author reviewed the selected articles in categories assigned to them. All authors participated in the final review process. Conclusions: Recent evidence has purported a relationship between mortality and FO, which can be validated by prospective RCTs (randomized controlled trials). The current literature demonstrates that "clinically significant" degree of FO could be below 10%. The lack of a standardized method to assess FB (fluid balance) and a universal definition of FO are issues that need to be addressed. To date, the impact of early goal directed therapy and utility of hemodynamic parameters in predicting fluid responsiveness remains underexplored in pediatric resuscitation. KEYWORDS: acute kidney injury; critical care; fluid overload; intensive care; pediatric nephrology PDF Síndrome de dificultad respiratoria aguda pediátrica: manejo de líquidos en la UCIP. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU. Ingelse SA1, Wösten-van Asperen RM1, Lemson J2, Daams JG3, Bem RA1, van Woensel JB1. Front Pediatr. 2016 Mar 21;4:21. doi: 10.3389/fped.2016.00021. eCollection 2016. Abstract The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar-capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes. KEYWORDS: PARDS; children; critical care; fluid balance; lung edema; management PDF International Symposium on Ultrasound, ISURA May 9-1. Porto, Portugal Información / Information Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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