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

CRITICAL CARE & EMERGENGY MEDICINE VOL. 5

Ultrasound-guided fluid therapy in the critically ill pediatric patient: integrating fluid tolerance and response

Enviar Artículo

www.doi.org/10.58281/ccem060126-rev-nar-11

Javier Ponce 1, 2 , Evelyn Obando 3 , Eduardo Tomas Alvarado 1, 4 , Edgardo Banille 5 , Pablo Bravo 6 , Leonel M. Fuentes G. 1, 7 , Mauricio Cantillano 1, 8 , Alfredo Rodríguez-Portelles 1, 9 , David Pascual Rojas Flores 1, 10 ,  Jaime Fernández- Sarmiento 11 .

1 Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
2 Hospital G. Rawson. San Juan, Argentina.
3 Fundación Santa Fe de Bogotá, Instituto Roosevelt, Universidad de La Sabana, Universidad de los Andes. Colombia.
4 IMSS, Instituto Mexicano del Seguro Social, Mexico.
5 Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
6 Jefe UPC Pediátrica Hospital San Juan de Dios., Santiago de Chile, Chile.
7 Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, CABA, Argentina.
8 Hospital del norte Instituto Hondureño de seguridad social San Pedro Sula, Honduras.
9 Hospital Metropolitano de Quito, Ecuador.
10 Instituto Mexicano del Seguro Social, México.
11 Departamento de Pediatría y Cuidado Intensivo Pediátrico. Universidad de La Sabana. Fundación Cardioinfantil-Instituto de Cardiología. Bogotá, Colombia.

Editor
Gerardo Alberto Solis Perez  , Arturo Vázquez Peralta .

Chair
Jorge M Antolinez-Motta

Abstract

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.

Resumen:  La administración óptima de fluidos intravenosos en pacientes críticos es fundamental para el manejo y monitoreo hemodinámico, especialmente durante episodios de shock. Este enfoque ha evolucionado de estrategias de reanimación líquida liberada a métodos restrictivos e individualizados, con el fin de evitar tanto hipovolemia como la sobrecarga
hídrica. La ecografía en el punto de atención (POCUS) en la actualidad es una herramienta no invasiva y con múltiples protocolos que nos ayudan en una mejor aproximación clínica. Se
destacan diversas técnicas ecográficas, incluyendo la evaluación de la función cardíaca (precarga, contractilidad y poscarga), así como la ecografía pulmonar y la valoración de la congestión vascular visceral mediante el protocolo VExUS. Estos métodos proporcionan información crítica sobre la tolerancia a fluidos, la respuesta a los mismos y el estado de la función ventricular, lo que es esencial para optimizar la terapia de fluidos y minimizar complicaciones asociadas a estados de hipovolemia, hipervolemia o mala distribución de volumen circulante. La interacción entre la ecografía y la evaluación hemodinámica tradicional es fundamental para una atención personalizada de la reanimación de pacientes pediátricos críticos

Fluid Therapy; Shock; Hemodynamics; Critical Illness; Ultrasonography; Point-of-Care Systems; Pediatrics

Javier Ponce.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital G. Rawson. San Juan, Argentina.

Evelyn Obando.
Fundación Santa Fe de Bogotá, Instituto Roosevelt, Universidad de La Sabana, Universidad de los Andes. Colombia.

Eduardo Tomas Alvarado.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
IMSS, Instituto Mexicano del Seguro Social, Mexico.

Edgardo Banille.
Hospital Privado Universitario de Córdoba, Córdoba, Argentina.

Pablo Bravo.
Jefe UPC Pediátrica Hospital San Juan de Dios., Santiago de Chile, Chile.

Leonel M. Fuentes G.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, CABA, Argentina.

Mauricio Cantillano.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital del norte Instituto Hondureño de seguridad social San Pedro Sula, Honduras.

Alfredo Rodríguez-Portelles.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital Metropolitano de Quito, Ecuador. 

David Pascual Rojas Flores.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Instituto Mexicano del Seguro Social, México.

Jaime Fernández-Sarmiento.
Departamento de Pediatría y Cuidado Intensivo Pediátrico. Universidad de La Sabana. Fundación Cardioinfantil-Instituto de Cardiología.
Bogotá, Colombia.

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Javier Ponce, Evelyn Obando, Eduardo Tomas Alvarado, Edgardo Banille, Pablo Bravo, Leonel M. Fuentes G., Mauricio Cantillano, Alfredo Rodríguez-Portelles, David Pascual Rojas Flores, and Jaime Fernández-Sarmiento. 2026. Terapia de fluidos guiada por ecografía en el paciente crítico pediátrico: integrando tolerancia y respuesta a fluidos. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 118–133. https://doi.org/10.58281/ccem060126-rev-nar-11
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eISSN: 2992-6785
DOI: 10.3989/ccem

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Patrocinadores

www.doi.org/10.58281/ccem060126-rev-nar-11

Javier Ponce 1, 2 , Evelyn Obando 3 , Eduardo Tomas Alvarado 1, 4 , Edgardo Banille 5 , Pablo Bravo 6 , Leonel M. Fuentes G. 1, 7 , Mauricio Cantillano 1, 8 , Alfredo Rodríguez-Portelles 1, 9 , David Pascual Rojas Flores 1, 10 ,  Jaime Fernández- Sarmiento 11 .

1 Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
2 Hospital G. Rawson. San Juan, Argentina.
3 Fundación Santa Fe de Bogotá, Instituto Roosevelt, Universidad de La Sabana, Universidad de los Andes. Colombia.
4 IMSS, Instituto Mexicano del Seguro Social, Mexico.
5 Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
6 Jefe UPC Pediátrica Hospital San Juan de Dios., Santiago de Chile, Chile.
7 Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, CABA, Argentina.
8 Hospital del norte Instituto Hondureño de seguridad social San Pedro Sula, Honduras.
9 Hospital Metropolitano de Quito, Ecuador.
10 Instituto Mexicano del Seguro Social, México.
11 Departamento de Pediatría y Cuidado Intensivo Pediátrico. Universidad de La Sabana. Fundación Cardioinfantil-Instituto de Cardiología.
Bogotá, Colombia.

Editor
Gerardo Alberto Solis Perez  , Arturo Vázquez Peralta .

Chair
Jorge M Antolinez-Motta

Abstract

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.

Resumen:  La administración óptima de fluidos intravenosos en pacientes críticos es fundamental para el manejo y monitoreo hemodinámico, especialmente durante episodios de shock. Este enfoque ha evolucionado de estrategias de reanimación líquida liberada a métodos restrictivos e individualizados, con el fin de evitar tanto hipovolemia como la sobrecarga
hídrica. La ecografía en el punto de atención (POCUS) en la actualidad es una herramienta no invasiva y con múltiples protocolos que nos ayudan en una mejor aproximación clínica. Se
destacan diversas técnicas ecográficas, incluyendo la evaluación de la función cardíaca (precarga, contractilidad y poscarga), así como la ecografía pulmonar y la valoración de la congestión vascular visceral mediante el protocolo VExUS. Estos métodos proporcionan información crítica sobre la tolerancia a fluidos, la respuesta a los mismos y el estado de la función ventricular, lo que es esencial para optimizar la terapia de fluidos y minimizar complicaciones asociadas a estados de hipovolemia, hipervolemia o mala distribución de volumen circulante. La interacción entre la ecografía y la evaluación hemodinámica tradicional es fundamental para una atención personalizada de la reanimación de pacientes pediátricos críticos

Fluid Therapy; Shock; Hemodynamics; Critical Illness; Ultrasonography; Point-of-Care Systems; Pediatrics

Javier Ponce.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital G. Rawson. San Juan, Argentina.

Evelyn Obando.
Fundación Santa Fe de Bogotá, Instituto Roosevelt, Universidad de La Sabana, Universidad de los Andes. Colombia.

Eduardo Tomas Alvarado.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
IMSS, Instituto Mexicano del Seguro Social, Mexico.

Edgardo Banille.
Hospital Privado Universitario de Córdoba, Córdoba, Argentina.

Pablo Bravo.
Jefe UPC Pediátrica Hospital San Juan de Dios., Santiago de Chile, Chile.

Leonel M. Fuentes G.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, CABA, Argentina.

Mauricio Cantillano.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital del norte Instituto Hondureño de seguridad social San Pedro Sula, Honduras.

Alfredo Rodríguez-Portelles.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Hospital Metropolitano de Quito, Ecuador. 

David Pascual Rojas Flores.
Miembro fundador del Grupo para la docencia. Investigación en Ecografía Multisistémica Pediátrica USPed Latinoamérica.
Instituto Mexicano del Seguro Social, México.

Jaime Fernández-Sarmiento.
Departamento de Pediatría y Cuidado Intensivo Pediátrico. Universidad de La Sabana. Fundación Cardioinfantil-Instituto de Cardiología.
Bogotá, Colombia.

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Javier Ponce, Evelyn Obando, Eduardo Tomas Alvarado, Edgardo Banille, Pablo Bravo, Leonel M. Fuentes G., Mauricio Cantillano, Alfredo Rodríguez-Portelles, David Pascual Rojas Flores, and Jaime Fernández-Sarmiento. 2026. Terapia de fluidos guiada por ecografía en el paciente crítico pediátrico: integrando tolerancia y respuesta a fluidos. CRITICAL CARE & EMERGENGY MEDICINE 5, (January 2026), 118–133. https://doi.org/10.58281/ccem060126-rev-nar-11
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