A CFB POD1 ≥ 5% was observed in 36% of pediatric cardiac surgery patients and was associated with adverse PICU outcomes including acute kidney injury, higher vasoactive inotropic scores, prolonged ventilation, longer PICU stay, and lower cardiac event-free survival.
A clinically relevant cumulative fluid balance of ≥5% at end of postoperative day 1 occurred in more than one-third of pediatric cardiac surgery patients.
Lower body weight and longer cardiopulmonary bypass time were identified as explanatory variables for developing a CFB POD1 ≥ 5%.
Patients with CFB POD1 ≥ 5% experienced more acute kidney injury and higher vasoactive inotropic scores compared to those without.
Patients with CFB POD1 ≥ 5% had prolonged invasive mechanical ventilation and longer PICU length of stay.
Patients with CFB POD1 ≥ 5% had significantly lower cardiac event-free survival time during long-term follow-up.
This research suggests that a significant proportion of children who undergo open-heart surgery with a heart-lung bypass machine accumulate excess fluid in their bodies shortly after the operation. In a study of 200 pediatric patients, 36% had a fluid overload of at least 5% of their body weight by the end of the first day after surgery. Younger, smaller children and those who spent longer time on the bypass machine were most likely to develop this level of fluid accumulation. The study found that children with this degree of fluid overload had worse outcomes during their intensive care stay, including more kidney injury, greater need for medications to support heart function, longer time on a breathing machine, and longer stays in the pediatric intensive care unit. Specifically, each additional 1% of fluid overload was associated with nearly an extra day in the ICU. Beyond the immediate hospital stay, children with higher fluid levels were also more likely to experience cardiac events during long-term follow-up. This research suggests that even what might seem like a modest amount of fluid accumulation—5%—is clinically meaningful and common in this population. Tracking fluid balance closely after pediatric heart surgery may help clinicians identify children who are at risk for a more difficult recovery, both in the short and long term, and prompt more attentive monitoring and follow-up care.
Luppes V, Pamir Z, Blom N, Hazekamp M, Roeleveld P, Houben N, et al.. (2026). Fluid balance during PICU stay in children after cardiac surgery with cardiopulmonary bypass.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07231-8