Pediatric fluid resuscitation: an oxymoron?

• Díaz, Franco

• Sepsis

In conclusion, fluid therapy is vital for caring for critically ill children, but the rationale for employing fluid boluses as a blind blanket treatment for hemodynamic instability requires thorough reassessment. A comprehensive understanding of fluids as a drug in critical care, including a dose, duration, and de-escalation (4D’s defined by Malbrain et al.), is essential, with specific indications and duration (25). A more rational, individualized approach may facilitate the adoption of alternative strategies aimed at minimizing excessive fluid administration and preventing fluid overload (26). As underscored by FernandezSarmiento et al. (13), it is imperative that clinicians systematically assess and clearly document, at least on a daily basis, the current phase of critical illness in each pediatric patient to ensure fluid management is appropriately tailored. Given the mounting evidence highlighting the potential harms and only transient benefits of fluid resuscitation, a precise, individualized, and context-driven approach to fluid therapy is no longer optional—it is essential. Such a strategy is crucial for optimizing outcomes and minimizing iatrogenic complications in critically ill children globally