Terapia de fluidos guiada por ecografía en el paciente crítico pediátrico: integrando tolerancia y respuesta a fluidos

Abstract: Optimal intravenous fluid administration in critically ill patients is essential for effective hemodynamic management, particularly during episodes of shock. Over time, fluid resuscitation strategies have evolved from liberal approaches to restrictive and individualized methods in order to prevent both hypovolemia and fluid overload, especially considering that only about 50% of critically ill patients are truly fluid responsive. Point-of-care ultrasound (POCUS) has emerged as a valuable, noninvasive bedside tool for assessing intravascular volume status and real-time hemodynamics. Several ultrasound-based techniques can be used, including cardiac ultrasound to evaluate preload, contractility, and afterload; lung ultrasound to detect pulmonary edema; and the Venous Excess Ultrasound Score (VExUS) to assess visceral venous congestion. These ultrasound assessments provide essential information on fluid responsiveness, right ventricular function, and tolerance to additional fluid administration. This enables clinicians to optimize fluid therapy while minimizing complications related to fluid overload. The integration of POCUS into clinical practice improves the ability of pediatric intensivists to tailor treatments to each patient’s hemodynamic profile, ultimately enhancing clinical outcomes. The combination of ultrasound and hemodynamic evaluation opens new possibilities for precision fluid management in the resuscitation of critically ill pediatric patients.