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Research Snapshot Theater: Pulmonary, Pediatric III

Fluid Balance in Children Receiving Noninvasive Respiratory Support in a Pediatric ICU

Tuesday, March 24, 2026
11:15 AM - 12:15 PM Central Time
Location: Connections Central - RST 13
Introduction: Children with lower respiratory tract illnesses (LRI) often need pediatric intensive care (PICU) for invasive or non-invasive respiratory support (NIRS). NIRS may reduce mortality, ventilation duration, and hospital stay. Fluid overload was associated with prolonged ventilation and ICU stays, but there is limited evidence on how fluid management affects children receiving non-invasive respiratory support. This study aims to determine fluid overload in children with LRI on NIRS and assess their clinical outcomes.


Methods: This prospective cohort study was conducted in a twelve-bed PICU. We included children aged 1 month to < 18 years with LRI (pneumonia, bronchiolitis, and asthma) receiving NIRS for >24 hours. Daily fluid balances were recorded, with cumulative and peak FO% defined as highest positive balance divided by admission weight. Ten percent of FO was considered a critical point. Outcome variables included PICU stay, oxygenation index (SpO2/FiO2 ratio), intubation, organ dysfunction, and mortality. We analyzed associations between fluid parameters, NIRS duration, and PICU LOS using multivariate analysis (p < 0.05).


Results: Of 290 screened patients, 260 with respiratory illness were included. Median age was 12 months (IQR: 5-36), with 49.61% under one year. Diagnoses included pneumonia (41%), bronchiolitis (26%), and asthma (15%). Of 260 patients, 191 (73%) had positive cumulative fluid balance. Peak FO% was < 10% in 200 children. Analysis showed age associated with fluid overload (p=0.001) for 1-5- and 5-10-year groups, but fluid overload showed no significant association with prolonged ventilation, MODS, or PICU stay.


Conclusions: In children with LRI receiving NIRS, fluid overload was frequently observed; however, it was not independently associated with the duration of NIRS or PICU LOS.