Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Fluid Management

Pediatr Crit Care Med. 2016 Mar;17(3 Suppl 1):S35-48. doi: 10.1097/PCC.0000000000000633.


Objective: In this Consensus Statement, we review the etiology and pathophysiology of fluid disturbances in critically ill children with cardiac disease. Clinical tools used to recognize pathologic fluid states are summarized, as are the mechanisms of action of many drugs aimed at optimal fluid management.

Data sources: The expertise of the authors and a review of the medical literature were used as data sources.

Data synthesis: The authors synthesized the data in the literature in order to present clinical tools used to recognize pathologic fluid states. For each drug, the physiologic rationale, mechanism of action, and pharmacokinetics are synthesized, and the evidence in the literature to support the therapy is discussed.

Conclusions: Fluid management is challenging in critically ill pediatric cardiac patients. A myriad of causes may be contributory, including intrinsic myocardial dysfunction with its associated neuroendocrine response, renal dysfunction with oliguria, and systemic inflammation with resulting endothelial dysfunction. The development of fluid overload has been associated with adverse outcomes, including acute kidney injury, prolonged mechanical ventilation, increased vasoactive support, prolonged hospital length of stay, and mortality. An in-depth understanding of the many factors that influence volume status is necessary to guide optimal management.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Review

MeSH terms

  • Cardiac Output
  • Cardiac Surgical Procedures
  • Child
  • Coronary Care Units
  • Critical Care / standards*
  • Diuretics / administration & dosage
  • Diuretics / adverse effects
  • Edema, Cardiac / drug therapy*
  • Edema, Cardiac / etiology
  • Fluid Therapy / adverse effects
  • Fluid Therapy / methods
  • Fluid Therapy / standards*
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / surgery
  • Heart Failure / etiology
  • Heart Failure / surgery
  • Heart Failure / therapy*
  • Humans
  • Intensive Care Units, Pediatric
  • Postoperative Complications / therapy


  • Diuretics