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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Fluid Management

McCammond, Amy N. MD; Axelrod, David M. MD; Bailly, David K. DO; Ramsey, E. Zachary PharmD; Costello, John M. MD, MPH

doi: 10.1097/PCC.0000000000000633

Objective: In this Consensus Statement, we review the etiology and pathophysiology of fluid disturbances in critically ill children with cardiac disease. Clinical tools used to recognize pathologic fluid states are summarized, as are the mechanisms of action of many drugs aimed at optimal fluid management.

Data Sources: The expertise of the authors and a review of the medical literature were used as data sources.

Data Synthesis: The authors synthesized the data in the literature in order to present clinical tools used to recognize pathologic fluid states. For each drug, the physiologic rationale, mechanism of action, and pharmacokinetics are synthesized, and the evidence in the literature to support the therapy is discussed.

Conclusions: Fluid management is challenging in critically ill pediatric cardiac patients. A myriad of causes may be contributory, including intrinsic myocardial dysfunction with its associated neuroendocrine response, renal dysfunction with oliguria, and systemic inflammation with resulting endothelial dysfunction. The development of fluid overload has been associated with adverse outcomes, including acute kidney injury, prolonged mechanical ventilation, increased vasoactive support, prolonged hospital length of stay, and mortality. An in-depth understanding of the many factors that influence volume status is necessary to guide optimal management.

1Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR.

2Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, CA.

3Division of Pediatric Critical Care, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, UT.

4Department of Pharmacy, the Children’s Hospital of Philadelphia, Philadelphia, PA.

5Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.

Dr. Costello’s effort for this article was supported in part by a generous gift from Mr. and Mrs. Warren and Eloise L. Batts (Chicago, IL). Dr. Costello’s institution received funding from Mr. and Mrs. Warren and Eloise L. Batts (Chicago, IL). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies