Introduction: Fluid overload (FO) is a common complication in critically ill children and has been linked to adverse outcomes, including multiple-organ dysfunction syndrome (MODS), prolonged hospitalization, and higher mortality. We evaluated whether FO within the first 7 days of PICU admission is associated with morbidity and mortality in pediatric patients. Methods: We performed a single-center, retrospective cohort study at Aga Khan University Hospital (September 2018 – December 2022). All patients aged 1 month–18 years who remained in the PICU >48 h were eligible. Data was extracted from the electronic medical record and analyzed with SPSS. Cumulative fluid accumulation, mortality, length of stay, duration of mechanical ventilation, and occurrence of MODS were recorded. Positive FO was defined as cumulative fluid accumulation >10 %. Results: Of 2,874 PICU admissions, 1,633 met inclusion criteria. Positive FO occurred in 1,380 patients (84.5 %). Mortality was higher in the FO-positive group (10.7 %) than in the FO-negative group (6.3 %; P = 0.034). Fluid accumulation >10 % at 24 h and 48 h was also associated with mortality (P = 0.037 and P = 0.005, respectively). MODS was more frequent among FO-negative patients (71.9 %; P 10 % over the first 7 days was not independently associated with mortality (P = 0.093). Conclusions: Early fluid accumulation in the PICU is associated with increased mortality in critically ill pediatric patients, underscoring the need for vigilant fluid monitoring and timely intervention. Prospective studies should clarify the threshold and timing of FO that most strongly influence clinical outcomes.
Jamshaid et al. (Sun,) studied this question.