**4.3. Maintenance volume**

In patients with critical illness and treated in the ICU, FO should be avoided [23]. Treatment of fluid administration depends on each individual in the resuscitation phase. As described earlier, FO is associated with high morbidity and mortality [28]. After returning blood pressure or on children returning heart rate is more valuable, the primary focus is adequate oxygen delivery to the tissue, which is directly related to cardiac output, hemoglobin concentration, and arterial saturation [32].

The use of sedation drugs may cause vasiness and increase hemodynamic instability and thus increases the risk of excessive fluid administration. Provision of sedation also makes the patient should bed rest and is a risk factor for microvascular dysfunction and eventually fluid fertilization returns. This of course increases the time of ventilator use and increases the

Measuring and Managing Fluid Overload in Pediatric Intensive Care Unit

http://dx.doi.org/10.5772/intechopen.79293

9

Fluid overload is an event that is often found in the intensive care room of children. This is in because the more severe the patient the more fluid administered, not only through infusion, but the provision of drugs and nutrients are also no less. Some recent research has found that fluid overload has many negative effects, particularly, in patients who have both sepsis and ARDS. In sepsis and ARDS patients, the initial fluid administration is able to increase disease survival rate but at 48, 72 and 96 h of fluid administration may result in an increase in mortality. Strength monitoring and restriction of fluid volume after resuscitation phase become an important step in order not to fall on fluid overload. Resuscitation should be subjective, and when the hemodynamic is stable, the volume of fluid should be handled either by direct reduction or by diuretics. Fluid overload generally associated with increased mortality, morbidity, duration of mechanical ventilation, length of hospitalization and the need for renal

Critical Care Medicine, Udayana University Sanglah Hospital, Denpasar, Bali, Indonesia

[1] Willson DF, Thomas NJ, Tamburro R, Truemper E, Truwit J, Conaway M, et al. The relationship of fluid administration to outcome in the pediatric calfactant in acute respi-

[2] Flori HR, Church G, Liu KD, Gildengorin G, Matthay M. Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients

[3] Arikan AA, Zappittelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children.

ratory distress syndrome trial. Pediatric Critical Care Medicine. 2013;**14**:666-672

with acute lung injury. Critical Care Research and Practice. 2011;**2011**:854142

length of stay in the ICU and the hospital [36].

**5. Conclusion**

replacement therapy (RRT).

Address all correspondence to: dyahpediatric@yahoo.com

Pediatric Critical Care Medicine. 2012;**13**(3):253-258

**Author details**

Dyah Kanya Wati

**References**

Conservative fluid management is associated with increased oxygen levels, decreased ventilator usage time, and decreased hospitalization. Patients treated in the ICU room on average will get fluid overload problems. Beside direct administration of fluids through venous access, these patients also receive fluids through drug administration and nutrient feeding and thus increasing the risk of fluid overload. However, in the maintenance phase, it is important to minimize the administration of unnecessary fluids [1, 33]. When FO is identified in a patient with stable hemodynamic and vasopressor reduction, fluid reduction should be the primary target to avoid negative FO effects [32].
