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Background: Positive fluid balance (FB) is associated with poor outcomes in critically ill children but has not been studied in pediatric liver transplant (LT) recipients. Our goal is to investigate the relationship between postoperative FB and outcomes in pediatric LT recipients. Methods: We performed a retrospective cohort study of first‐time pediatric LT recipients at a quaternary care children's hospital. Patients were stratified into three groups based on their FB in the first 72 h postoperatively: <10%, 10–20%, and > 20%. Outcomes were pediatric intensive care unit (PICU) and hospital length of stay, ventilator‐free days (VFD) at 28 days, day 3 severe acute kidney injury, and postoperative complications. Multivariate analyses were adjusted for age, preoperative admission status, and Pediatric Risk of Mortality (PRISM)‐III score. Results: We included 129 patients with median PRISM‐III score of 9 (interquartile range, IQR 7–15) and calculated Pediatric End‐stage Liver Disease score of 15 (IQR 2–23). A total of 37 patients (28.7%) had 10–20% FB, and 26 (20.2%) had >20% FB. Greater than 20% FB was associated with an increased likelihood of an additional PICU day (adjusted incident rate ratio [aIRR] 1.62, 95% CI: 1.18–2.24), an additional hospital day (aIRR 1.39, 95% CI: 1.10–1.77), and lower likelihood of a VFD at 28 days (aIRR 0.85, 95% CI: 0.74–0.97). There were no differences between groups in the likelihood of postoperative complications. Conclusions: In pediatric LT recipients, >20% FB at 72 h postoperatively is associated with increased morbidities, independent of age and severity of illness. Additional studies are needed to explore the impact of fluid management strategies on outcomes. [ABSTRACT FROM AUTHOR]

To honor Lauren and her many contributions to our academic community, her family and we have established the endowed Lauren Marsillio-Craney Annual Lectureship in Pediatric Critical Care Science or Autonomic Medicine. Upon graduation, Lauren worked for the Health and Human Services (HHS) in the office of the Assistant Surgeon General. To honor Lauren and her many contributions to our academic community, her family and we have established the endowed Lauren Marsillio-Craney Annual Lectureship in Pediatric Critical Care Science or Autonomic Medicine Intrinsic to Lauren were her prodigious talent, her innovative predictive analytics in the critical care unit setting, and her great passion for highly applied big data research to help children survive critical illness and injury. [Extracted from the article]

Chloride load's association with VFD, hospital LOS, in-hospital mortality, and change in serum chloride from baseline was not significant after adjusting for confounders. B Introduction: b Hyperchloremia is associated with increased morbidity and mortality in critically ill children, but it is unknown if the intravenous (IV) chloride amount administered (chloride load) is associated with hyperchloremia or poor outcomes. B Conclusions: b IV chloride load is independently associated with decreased odds of day 2 and 3 severe AKI, increased odds of hyperchloremia, and higher day 2 serum chloride in critically ill children. [Extracted from the article]

At least 2hrs were required between boluses and every bolus had at least 30sec of adequate pre-bolus arterial waveform data. We hypothesized that as dp/dtmax has previously been associated with SV response, dp/dtmax would also be associated with mean arterial pressure (MAP) response to bolus. Future studies of dp/dtmax in particular - and fluid responsiveness in general - may want to consider the effects of SVR in addition to SV when assessing clinical response to IV fluid bolus. [Extracted from the article]

B Introduction: b Fluid boluses are commonly administered to children with hypotension, but response is variable. At least 2hrs were required between boluses and every bolus had at least 30sec of adequate pre-bolus arterial waveform data. Fluid responsiveness (FR) was defined as increase by >= 10% in MAP from pre-bolus to average 20 min post-bolus. [Extracted from the article]

Our aim was to determine whether heart rate variability, which is a measure of autonomic nervous system function, is associated with pro-inflammatory biomarker levels in critically ill children. B Results: b Sixty-two patients met inclusion criteria in the prospective cohort and 599 patients in the retrospective cohort. Heart rate variability (HRV) was measured using the age-adjusted integer HRV (HRVi), which is the standard deviation of the heart rate sampled every 1 second over 5 consecutive minutes and age-normalized. [Extracted from the article]

B Results: b Our population consisted of 141 patients, 71 (50.4%) with biliary atresia, median PELD/MELD score of 15 (2-24), and 47 (33.3%) patients were admitted to the hospital prior to LT. Bivariate and multivariate regression analyses were done to assess the relationship between FO (cumulative fluid balance (CFB) through POD 3 divided by pre-LT weight) and intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days in 28 (VFD), in-hospital mortality, and severe AKI (stage 2 or 3). Post-LT, there was a median PRISMIII score of 9 (7-14), 10 (7.1%) had hepatic artery and/or portal vein thrombosis, and 31 (22.0%) received >=40 mL/kg of blood product by POD 3. 70 (49.6%) patients had < 10% CFB, 41 (29.1%) patients had 10-20% CFB, and 30 (21.3%) patients had > 20% CFB. [Extracted from the article]