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Fluid Management: Pharmacologic and Renal Replacement Therapies

Wald, Eric L. MD, MSCI; Finer, Gal MD; McBride, Mary E. MD, MEd; Nguyen, Nguyenvu MD; Costello, John M. MD, MPH; Epting, Conrad L. MD

doi: 10.1097/PCC.0000000000000781
Organ Systems: Other Organ Systems and Systemic Disorders
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Objectives: Focusing on critically ill children with cardiac disease, we will review common causes of fluid perturbations, clinical recognition, and strategies to minimize and treat fluid-related complications.

Data Source: MEDLINE and PubMed.

Conclusions: Meticulous fluid management is vital in critically ill children with cardiac disease. Fluid therapy is important to maintain adequate blood volume and perfusion pressure in order to support cardiac output, tissue perfusion, and oxygen delivery. However, fluid overload and acute kidney injury are common and are associated with increased morbidity and mortality. Understanding the etiologies for disturbances in volume status and the pathophysiology surrounding those conditions is crucial for providing optimal care.

1Divisions of Critical Care and Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

2Division of Kidney Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

3Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL.

Dr. Costello’s contributions to this article were supported in part by an endowment established for the Division of Cardiology at Ann & Robert H. Lurie Children’s Hospital of Chicago by Mr. Warren Batts. Dr. Costello is employed by the Ann & Robert H. Lurie Children’s Hospital of Chicago and provided expert testimony for White & Williams. Dr. Epting disclosed other support (uncompensated scientific advisory board for Vivacelle Bio, Inc.). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: ewald@luriechildrens.org

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