Fluid deresuscitation in critically ill children: comparing perspectives of intensivists and nephrologists

• DOI: 10.3389/fped.2024.1484893
• Publication Date: 2024-10-28T10:37:47Z
• Authors: Chloe G. Braun; David J. Askenazi; Javier A. Neyra; Priya Prabhakaran; A. K. M. Fazlur R...; Tennille N. Webb; James D. Odum
• Keywords: Vignette

Introduction Fluid accumulation, presently defined as a pathologic state of overhydration/volume overload associated with clinical impact, is common and worse outcomes. At times, deresuscitation, the active removal fluid via diuretics or ultrafiltration, necessary. There no consensus regarding deresuscitation in children admitted to pediatric intensive care unit. Little known perceptions practices among intensivists nephrologists provision deresuscitation. Methods Cross-sectional electronic survey from academic societies United States designed better understand management between disciplines. A vignette was used characterize optimal timing method initiation at four timepoints that correspond different stages shock. Results In total, 179 respondents (140 intensivists, 39 nephrologists) completed survey. Most 75.4% (135/179) providers believe discussing balance initiating unit (PICU) patients “very important”. The first time point (corresponding resuscitation phase early shock) had most dissimilarity ( p = 0.01) regards However, demonstrated increasing agreement their responses initiate progressed. Compared were more likely choose “dialysis ultrafiltration” during optimization [10.3 vs. 2.9% 0.07)], stabilization [18.0% 3.6% < 0.01)], evacuation [48.7% 23.6% 0.01)] phases Conversely, utilize scheduled than [47.1% 28.2% 0.04)] later on patient course. Discussion physicians important. Nevertheless, when how accomplish it differed nephrologist intensivists. Widely understood operationalizable definitions, further research, eventually evidence-based guidelines are needed help guide care.