Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background : Acute kidney injury(AKI) is one of the common conditions in critically ill children . Fluid status assessment in patients with AKI is considered difficult and either excess fluid removal or fluid overload is associated with poor outcome and high morbidity.The aim of the present study is to evaluate the clinical utility of thoracic fluid content (TFC) measured by electrical impedence cardiometry as an indicator of fluid status in critically ill children with acute kidney injury.Methods : A cross sectional study was done over a period of 18 months, where 72 critically ill children with AKI were enrolled.Estimation of TFC by using non invasive cardiometry was done at the onset of AKI and during follow up to determine fluid status of patients, in association with other clinical and imaging parameters.Results: The change in TFC significantly correlated with changes in fluid balance ( r=0.316,p=0.007) and changes in central venous pressure in both dialysis and conservative groups (r=0.617,p=0.002& r=0.6,p=0.00 respectively). At the onset of AKI ,TFC was significantly associated with inferior vena cava (IVC) status by ultrasound in the non dialysis group .Overloaded patients had significantly higher TFC than non overloaded patients who required dialysis with other indications (p=0.03and 0.043 before and after dialysis respectively) and those managed conservatively (p=0.029 and 0.041at onset and follow up of AKI respectively).Conclusion: TFC measurement by using non invasive cardiometry could be a useful tool in monitoring fluid status and response to therapy in AKI patients

Issued also as CD