A Standardized Approach to Reduce Fluid Overload in Critically Ill Children

Abstract

Introduction: Fluid overload, the pathologic state of positive fluid balance, is common in the pediatric intensive care unit (PICU) and is independently associated with poor outcomes. Quality improvement-based processes to measure and assess fluid balance in critically ill children are lacking. Methods: The primary aim was to develop and implement a fluid management strategy that includes the standardized measurement and assessment of fluid balance, which is adhered to in at least 50% of all PICU patients. The 4 components of the strategy include (1) creating a fluid balance dashboard that tracks percent cumulative fluid balance over time, (2) documentation of daily weights, (3) fluid balance reporting and discussion incorporated into standardized rounds, and (4) active total intravenous (IV) fluid order. Results: We reviewed 280 patient encounters between May 2023 and April 2024 and achieved the primary aim of at least 50% compliance with the fluid management strategy and maintained this success over time. Achieving the primary aim coincides with implementing daily weights and total IV fluid orders into PICU admission order sets. Conclusions: In this quality improvement project, we develop, implement, and maintain compliance with a fluid management strategy. Future work will involve daily utilization of the fluid balance dashboard and monitoring compliance with total IV fluid orders. Implementing a quality improvement-based fluid management strategy may lead to improved awareness of the fluid status of patients and the prescription of fluid therapy to mitigate the harmful effects of fluid overload.