Background Pediatric patients undergoing cardiac surgery are at risk for developing positive cumulative fluid balance (CFB). Our goal was to study postoperative CFB in this population, its explanatory variables, and its effect on clinical outcomes during pediatric intensive care unit (PICU) stay and follow-up. Methods Retrospective single center study of 200 consecutive children undergoing congenital heart surgery with cardiopulmonary bypass (CPB). A clinically relevant CFB was defined as ≥ 5% at the end of postoperative day 1 (CFB POD1 ≥ 5%). Results A CFB POD1 ≥ 5% was observed in 36% of the patients. Lower weight and longer CPB time were identified as explanatory variables for developing CFB POD1 ≥ 5%. Patients with CFB POD1 ≥ 5% showed more acute kidney injury, higher vasoactive inotropic scores, and prolonged invasive ventilation and PICU length of stay (LOS). A 1% increase in CFB POD1 lengthened PICU LOS by 0.8 days (CI 0.588 – 1.001, p < 0.001). Furthermore, patients with CFB POD1 ≥ 5% had lower cardiac event free survival time (p < 0.001). Conclusions This study confirms that even a minor positive CFB ≥ 5% is common in pediatric cardiac patients and associated with adverse PICU outcomes. Lower body weight and prolonged CPB duration increased the risk for positive CFB, warranting close fluid monitoring. Positive CFB was also associated with cardiac events during long-term follow-up and may help identify patients at increased risk for a complicated clinical trajectory, underscoring the importance of timely recognition and structured cardiac follow-up. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • Positive cumulative fluid balance (CFB) is associated with adverse outcomes in critically ill pediatric patients, including those undergoing congenital heart surgery, though causality remains unclear. • Evidence on optimal fluid management and clinically relevant CFB thresholds remains limited. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • This study confirms that a seemingly minor CFB of 5% is common and associated with adverse outcomes in a heterogenous pediatric cardiac cohort. • Positive CFB was additionally associated with adverse long-term outcomes, identifying positive CFB as a potential early marker of a complicated clinical course. </entry> </row> </tbody> </tgroup> </Table>

Fluid balance during PICU stay in children after cardiac surgery with cardiopulmonary bypass

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2026年7月10日

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Victorien A. C. Luppes,
Zala Pamir,
Nico A. Blom,
Mark G. Hazekamp,
Peter P. Roeleveld,
Nina A. M. Houben,
Jacobien B. Eising,
Ariane Willems,
Arend D. J. ten Harkel

摘要

Background

Pediatric patients undergoing cardiac surgery are at risk for developing positive cumulative fluid balance (CFB). Our goal was to study postoperative CFB in this population, its explanatory variables, and its effect on clinical outcomes during pediatric intensive care unit (PICU) stay and follow-up.

Methods

Retrospective single center study of 200 consecutive children undergoing congenital heart surgery with cardiopulmonary bypass (CPB). A clinically relevant CFB was defined as ≥ 5% at the end of postoperative day 1 (CFB POD1 ≥ 5%).

Results

A CFB POD1 ≥ 5% was observed in 36% of the patients. Lower weight and longer CPB time were identified as explanatory variables for developing CFB POD1 ≥ 5%. Patients with CFB POD1 ≥ 5% showed more acute kidney injury, higher vasoactive inotropic scores, and prolonged invasive ventilation and PICU length of stay (LOS). A 1% increase in CFB POD1 lengthened PICU LOS by 0.8 days (CI 0.588 – 1.001, p < 0.001). Furthermore, patients with CFB POD1 ≥ 5% had lower cardiac event free survival time (p < 0.001).

Conclusions

This study confirms that even a minor positive CFB ≥ 5% is common in pediatric cardiac patients and associated with adverse PICU outcomes. Lower body weight and prolonged CPB duration increased the risk for positive CFB, warranting close fluid monitoring. Positive CFB was also associated with cardiac events during long-term follow-up and may help identify patients at increased risk for a complicated clinical trajectory, underscoring the importance of timely recognition and structured cardiac follow-up.

What is Known:

• Positive cumulative fluid balance (CFB) is associated with adverse outcomes in critically ill pediatric patients, including those undergoing congenital heart surgery, though causality remains unclear.

• Evidence on optimal fluid management and clinically relevant CFB thresholds remains limited.

What is New:

• This study confirms that a seemingly minor CFB of 5% is common and associated with adverse outcomes in a heterogenous pediatric cardiac cohort.

• Positive CFB was additionally associated with adverse long-term outcomes, identifying positive CFB as a potential early marker of a complicated clinical course.