suryakumari journal club fluid overload.pptx

Gta 5

1. Association of fluid overload with mortality in critically ill mechanically ventilated children JOURNAL CLUB SURIYAKUMARI II YEAR POST GRADUATE DEPARTMENT OF PEADIATRICS

2. introduction Fluid balance is one of the most challenging aspects of critically ill children requiring picu care An excessive administration of fluids can lead to an imbalance in fluid haemostasis and cause fluid overload Mechanically ventilated children may be prone to fluid overload as they have lesser evaporative losses due to warmed, humidified gases and thermocontrolled environment Presence of non osmotic stimuli ,in addition to osmotic stimuli ,for anti diuretic release may contribute to fluid retention

3. PATHOGENESIS

4. ETIOLOGY Endothelial glycocalyx injury( sepsis,inflammation and fluid therapy) SIADH Excessive fluid resuscitation Fluid creep Inflammatory conditions Renal dysfunction Heart failure Hypoalbuminemia Administartion of hypertonic solutions Excessive sodium intake

5. Clinical settings leading to increase in adh : Hemodynamic stimuli of ADH release Non hemodynamic stimuli of ADH release Volume depleted states Pulmonary : Pneumonia, Asthma, TB, Mechanical ventilation Hypotension CNS: Meningitis, encephalitis, brain abscess, head injury Congestive cardiac failure Pain and stress Adrenal insuffeciency Guillian barre syndrome Nephrotic syndrome hypothyroidism Liver cirrhosis Infant botulism Medications: antidepressants, anticonvulsants,antipsychotics

6. Quantifying fluid overload % FLUID OVERLOAD: (daily fluid intake(L)-total output(L) X 100 baseline body weight

7. TITLE

8. BACKGROUND AND JUSTIFICATION Critically ill children are more likely to experience positive fluid balance as a result of underlying illness or its effects ,capillary leakage ,pro inflammatory states, compromised cardiopulmonary function, excessive resuscitation fluid during the acute phase, administration of more fluids than necessary during the maintenance phase ,unaccounted other fluids and mechanical ventilation This study aims to provide a comprehensive overview of the current understanding and management strategies for fluid overload among critically ill children

9. methodology Study design : PROSPECTIVE OBSERVATIONAL STUDY Study population : MECHANICALLY VENTILATED CHILDREN IN PICU 1Month to 15 years Duration of study: 20 months Sample size : 118

10. METHODOLOGY Inclusion criteria : All children(1 month to 15 yrs.) mechanically ventilated > 24hours Exclusion criteria : Mechanically ventilation <24 hrs Inadequate data Acute kidney injury Congenital heart disease CKD RTA Mechanical ventilation > 24hrs outside PICU

11. SCORES USED IN STUDY

12. PELOD SCORE

13. METHODOLOGY

14. results

15. conclusion There is no association of fluid overload with mortality . It is associated with poor organ function, longer duration of mechanical ventilation and stay in critically ill mechanically ventilated children