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Emergency care
In critically ill children, fluid overload is consistently associated with worse outcomes
  1. Ryan Barbaro1,
  2. Eddy Fan2
  1. 1 Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
  1. Correspondence to Dr Eddy Fan, Toronto General Hospital, Toronto, M5G 2N2, Canada;{at}

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Commentary on: Alobaidi R, Morgan C, Basu RK, et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(3):257–268.


Early goal-directed fluid resuscitation is the foundation of paediatric clinical practice parameters for septic shock and hypovolaemic shock management.1 Moderating fluid resuscitation is the observation that fluid overloaded children have higher mortality rates and longer lengths of stay.2 The Fluid Expansion as Supportive Therapy randomised controlled trial found African children with febrile illness and impaired perfusion who received fluid bolus therapy had a higher mortality rate than those who received no bolus therapy. However, it was conducted in hospitals without intensive care units and therefore does not generalise to high resource states.3 This systematic review and meta-analysis examines the measure and definition of fluid overload and its association with …

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  • Contributors RB drafted the manuscript and critically revised the content. EF critically revised the content.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.