Response by the Authors of the Original Article

Fluid Overload in the PICU: Still a Challenge

We thank Drs. Colleti and de Carvalho for the important comments on our article. We appreciate and agree with the limitations that they discuss regarding our study. The study began as a quality improvement project driven by our concern that clinicians in our unit were not considering fluid intake from medications consistently when accounting for total fluid intake. As a result, we decided to collect data for a predetermined 30-day period on our mechanically ventilated patients. We were motivated to share our data given that we suspect that a high proportion of fluid intake from medications in critically ill children is likely occurring in other intensive care units (ICUs) as well. We did not collect data on the type of fluid used and focused our analysis on patients 24 hours after intubation, presumably after the acute resuscitation period. Given that our data collection was limited to 30 days, our sample size is limited. As a result, we did not include an analysis or gather data on vasoactive agents or outcomes, although no patients died during the study period. We hope that this study generates interest in larger future studies investigating the role of medication volume in the fluid management of the critically ill pediatric and neonatal populations accounting for these limitations.