Conceito ROSE em fluidoterapia e efeitos do acúmulo de fluidos em pacientes pediátricos criticamente enfermos

Abstract

Fluid resuscitation is essential in the management of critically ill pediatric patients; however, fluid accumulation is associated with worse clinical outcomes, including prolonged invasive mechanical ventilation, longer pediatric intensive care unit stay, need for renal replacement therapy, and increased mortality. The ROSE concept (Resuscitation, Optimization, Stabilization, and Evacuation) proposes a dynamic and individualized approach to fluid therapy according to the different phases of shock, with specific targets for percentage fluid accumulation (FA%). This thesis aimed to implement the ROSE concept in the pediatric intensive care unit of Hospital das Clínicas, Federal University of Minas Gerais, and to evaluate its impact FA% and clinical outcomes. A quasi-experimental study was conducted with a retrospective cohort (2019–2022) and a prospective cohort (2023–2025), before and after implementation. Patients requiring invasive mechanical ventilation and vasoactive drugs were included. The healthcare team received prior training. The phases of fluid therapy were identified, FA% was calculated during hospitalization, and its association with duration of mechanical ventilation, need for renal replacement therapy, length of stay, and mortality was analyzed. Implementation proved feasible and improved fluid monitoring. FA% on the third day of admission was significantly associated with clinical outcomes, confirming its prognostic relevance. Systematic application of the ROSE concept may improve fluid control and enhance the quality of pediatric critical care.