Fluid Overload and Management

  • Leyat Tal
  • Manpreet Kaur Virk
  • Ayse Akcan ArikanEmail author


Critically ill patients have a high amount of fluid exposure due to the nature of their illness. Fluids are the sine qua non of successful intensive care unit (ICU) support, facilitating resuscitation, medication delivery, and nutrition. Context specific risk factors make ICU patients very vulnerable to fluid accumulation and fluid overload. Timely recognition might offer opportunities for successful intervention to treat, reverse, or prevent fluid overload. In this chapter, we will provide a brief overview of pathophysiology and then offer the reader a pragmatic approach to assessment and treatment of fluid overload.


Acute kidney injury Children Fluid overload Edema Dialysis 


  1. 1.
    Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol. 2016;17(1):109.CrossRefGoogle Scholar
  2. 2.
    Ware LB, Matthay MA. Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001;163(6):1376–83.CrossRefGoogle Scholar
  3. 3.
    Khemani E, McElhinney DB, Rhein L, Andrade O, Lacro RV, Thomas KC, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics. 2007;120(6):1260–9.CrossRefGoogle Scholar
  4. 4.
    Malnick G, Pickoff AS, Ferrer PL, Peyser J, Bancalari E, Gelband H. Normal pulmonary vascular resistance and left ventricular hypertrophy in young infants with bronchopulmonary dysplasia: an echocardiographic and pathologic study. Pediatrics. 1980;66(4):589–96.PubMedGoogle Scholar
  5. 5.
    Mourani PM, Sontag MK, Younoszai A, Ivy DD, Abman SH. Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease. Pediatrics. 2008;121(2):317–25.CrossRefGoogle Scholar
  6. 6.
    Soler YA, Nieves-Plaza M, Prieto M, García-De Jesús R, Suárez-Rivera M. Pediatric Risk, Injury, Failure, Loss, End-Stage renal disease score identifies acute kidney injury and predicts mortality in critically ill children: a prospective study. Pediatr Crit Care Med. 2013;14(4):e189–95.CrossRefGoogle Scholar
  7. 7.
    Alobaidi R, Morgan C, Basu RK, Stenson E, Featherstone R, Majumdar SR, et al. Associations between fluid balance and outcomes in critically ill children: a protocol for a systematic review and meta-analysis. Can J Kidney Health Dis. 2017;4(8):2054358117692560.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Selewski DT, Askenazi DJ, Bridges BC, Cooper DS, Fleming GM, Paden ML, et al. The impact of fluid overload on outcomes in children treated with extracorporeal membrane oxygenation: a multicenter retrospective cohort study. Pediatr Crit Care Med. 2017;18(12):1126–35.CrossRefGoogle Scholar
  9. 9.
    Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13(3):253–8.CrossRefGoogle Scholar
  10. 10.
    Valentine SL, Sapru A, Higgerson RA, Spinella PC, Flori HR, Graham DA, et al. Fluid balance in critically ill children with acute lung injury. Crit Care Med. 2012;40(10):2883–9.CrossRefGoogle Scholar
  11. 11.
    Flori HR, Church G, Liu KD, Gildengorin G, Matthay MA. Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury. Crit Care Res Pract. 2011;2011(4):854142–5.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Sinitsky L, Walls D, Nadel S, Inwald DP. Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study. Pediatr Crit Care Med. 2015;16(3):205–9.CrossRefGoogle Scholar
  13. 13.
    Barhight MF, Lusk J, Brinton J, Stidham T, Soranno DE, Faubel S, et al. Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy. Pediatr Nephrol. 2018;30(2):300.Google Scholar
  14. 14.
    Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901–11.CrossRefGoogle Scholar
  15. 15.
    Goldstein SL, Currier H, Cd G, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics. 2001;107(6):1309–12.CrossRefGoogle Scholar
  16. 16.
    Selewski DT, Cornell TT, Lombel RM, Blatt NB, Han YY, Mottes T, et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med. 2011;37(7):1166–73.CrossRefGoogle Scholar
  17. 17.
    Ng KT, Velayit A, Khoo DKY, Mohd Ismail A, Mansor M. Continuous infusion versus intermittent bolus injection of furosemide in critically ill patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2018;32(5):2303–10.CrossRefGoogle Scholar
  18. 18.
    Elbahlawan L, West NK, Avent Y, Cheng C, Liu W, Barfield RC, et al. Impact of continuous renal replacement therapy on oxygenation in children with acute lung injury after allogeneic hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2010;55(3):540–5.CrossRefGoogle Scholar
  19. 19.
    Kwiatkowski DM, Goldstein SL, Cooper DS, Nelson DP, Morales DLS, Krawczeski CD. Peritoneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery: a randomized clinical trial. JAMA Pediatr. 2017;171(4):357–64.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Leyat Tal
    • 1
    • 2
  • Manpreet Kaur Virk
    • 3
  • Ayse Akcan Arikan
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of PediatricsRenal Section, Baylor College of MedicineHoustonUSA
  2. 2.Critical Care NephrologyTexas Children’s HospitalHoustonUSA
  3. 3.Department of Pediatrics, Critical Care SectionBaylor College of MedicineHoustonUSA

Personalised recommendations