• Amy N McCammond, David M Axelrod, David K Bailly, E Zachary Ramsey, and John M Costello.
• 1Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR. 2Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA. 3Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT. 4Department of Pharmacy, the Children's Hospital of Philadelphia, Philadelphia, PA. 5Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
• Pediatr Crit Care Me. 2016 Mar 1; 17 (3 Suppl 1): S35-48.

ObjectiveIn 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 SourcesThe expertise of the authors and a review of the medical literature were used as data sources.Data SynthesisThe 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.ConclusionsFluid 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.

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