Fluid responsiveness in pediatric critical care

Abstract

Predicting fluid responsiveness in pediatric critical care share most adults issues. Clinical story and usual clinical hemodynamics parameters are often sufficient to start fluid volume (FV) resuscitation. The repetition of FV must be justified to reduce the fluid overload risks (tissue and pulmonary edema,, negative prognostic impact of a positive cumulative fluid balance). In either spontaneously or positively ventilated patient, carricatured static ultrasound criteria or passive leg raising can be used to validate the decision. In mechanical ventilation, respiratory variability of peak aortic velocity recorded by echo-Doppler remain the best validated dynamic parameter to date in children. In the operating theatre in particular, the PVI index of the plethysmography curve and the stroke volume indexed to body surface area can be used. In all cases, it is crucial to know the methodological limitations of these parameters, and to remember that arterial pulse pressure variation is not relevant in young children.