Association of Fluid Overload with Mortality in Critically-ill Mechanically Ventilated Children

Samaddar, Sukla; Sankar, Jhuma; Kabra, S. K.; Lodha, Rakesh

doi:10.1007/s13312-018-1417-y

Cited by 14 publications

(8 citation statements)

References 24 publications

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“…A study of mortality-related factors in CRRT for AKI also confirmed that MV, the use of vasoactive drugs and other factors were related to increased mortality [ 28 ]. It is also worth noting that in a study on FO and mortality in 118 children with MV [ 29 ], there was a significant correlation between FO and organ dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a single-center retrospective cohort study

Kong

Zhu

2021

BMC Pediatr

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Background Positive fluid overload (FO) may cause adverse effect. This study retrospectively analyzed the relationship between early FO and in-hospital mortality in children with mechanical ventilation (MV) in pediatric intensive care unit (PICU). Methods This study retrospectively enrolled 309 children (ages 28 days to 16 years) receiving invasive MV admitted to the PICU of Xinhua Hospital from March 2014 to March 2019. Children receiving MV for less than 48 h were excluded. The FO in the first 3 days of MV was considered to the early FO. Patients were divided into groups according to early FO and survival to evaluate the associations of early FO, percentage FO(%FO) > 10%, and %FO > 20% with in-hospital mortality. Results A total of 309 patients were included. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). There were no significant differences in mortality among different FO groups (P = 0.053) or in early FO between survivors and non-survivors (P = 0.992). Regression analysis demonstrated that use of more vasoactive drugs, the presence of multiple organ dysfunction syndrome, longer duration of MV, and a non-operative reason for PICU admission were related to increased mortality (P < 0.05). Although early FO and %FO > 10% were not associated with in-hospital mortality (β = 0.030, P = 0.090, 95% CI = 0.995–1.067; β = 0.479, P = 0.153, 95% CI = 0.837–3.117), %FO > 20% was positively correlated with mortality (β = 1.057, OR = 2.878, P = 0.029, 95% CI = 1.116–7.418). Conclusions The correlation between early FO and mortality was affected by interventions and the severity of the disease, but %FO > 20% was an independent risk factor for in-hospital mortality in critically ill MV-treated children.

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Section: Discussionmentioning

confidence: 99%

Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a single-center retrospective cohort study

Kong

Zhu

2021

BMC Pediatr

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“…Once the treatment of children with cancer involves the administration of large amounts of volume through the use of antimicrobials, hyperhydration, sedatives, chemotherapy, and transfusions, these patients show a higher risk of volume overload, especially in the presence of AKI with reduced urine flow rate. [25,26] Patients with positive cumulative fluid balance show longer mechanical ventilation time and greater need for RRT. [27] Raymakers-Janssen et al (2019) [28] observed in their multicentric study with pediatric cancer patients that fluid overload (p=0.003) and a need for inotropic support at the beginning of the continuous renal replacement therapy (p=0.004) are independent predictors of death.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in children with cancer admitted in an intensive care unit

Almeida,

Luiz,

De-Oliveira

et al. 2022

BJOncology

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Objective: Evaluating the association between acute kidney injury and death in critically ill children with oncological diseases admitted in an intensive care unit (ICU). Material and Methods: Unicentric cohort study, evolving children with cancer admitted in the ICU of a pediatrics referral hospital. The patients were divided according to the presence or absence of acute kidney injury. Patients with a history of urogenital disease, nephrectomy or chronic kidney disease were excluded. The acute kidney injury was defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification. The main outcome was death. Results: The sample was composed of 84 patients, in which 46.4% were diagnosed with hematologic neoplasm, 29.8% evolved with febrile neutropenia, 11.9% had a history of bone marrow transplant, and 27.3% deceased. Acute kidney injury occurred in 51.2% of the sample, 53.6% used furosemide, 38% showed fluid overload, and 8.3% had renal replacement therapy. The main variables related to kidney dysfunction were admission due to hemodynamic shock, pediatric risk of mortality score 2 ≥5%, bone marrow transplant, volume overload and multiple organ dysfunction syndrome.More advanced stages of acute kidney injury were associated with renal replacement therapy (p<0.001), longer stay in the ICU (p=0.006), and death (p=0.003). Conclusion: Children with cancer showed many risk factors of acute kidney injury, and this complication is associated with higher death rate.

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“…However, in children who are critically ill and on mechanical ventilation, it is linked to poor organ function, a longer time spent in the PICU, and a longer duration of mechanical ventilation. 13 Another prospective study demonstrated that 64 (17.3%) of the patients experienced early fluid overload within the first 24 hours of hospitalization. The PICU mortality rate of the overall group was 4.9%.…”

Section: Evidence From Literature For Adverse Effects Of Fluid Overloadmentioning

confidence: 99%

Adverse effects of fluid overload in different paediatric age groups

Althagafi¹,

Qartali²,

Alasmari

et al. 2022

Int J Community Med Public Health

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Fluid resuscitation is a routine procedure in the treatment of critically ill patients especially in paediatric intensive care units. Fluid overload can result from instability in fluid homeostasis caused by the administration of excessive fluids. Fluid overload can have a wide range of adverse impacts on paediatric critical care patients, including increased mortality risk. Fluid overload increases the length of hospital stay and ventilation time also elevates requirement for renal replacement treatment. The purpose of this research is to review the available information about adverse effects of fluid overload in different paediatric age groups. Literature suggests that fluid overload is associated with significant morbidity and mortality among children. Fluid overload percentage greater than 10% is linked to higher mortality rates among children. Respiratory failure can be triggered by pulmonary alveolar and interstitial edema caused by hypervolemia. Children suffering from acute kidney injury or other renal diseases experience more worsened conditions in presence of fluid overload. Fluid overload can impair organ performance, which can impact disease and fatality. Excessive fluid may alter the efficiency of the heart and perhaps impair cardiac function by considerably moving ventricular compliance to the right on the Frank-Starling curve. The negative effects of fluid overload make patients more susceptible to an elevated risk of morbidity and death even if fluid overload itself is not a direct indicator of mortality. Further research can in aid in developing preventive and management strategies for the fluid balance in paediatric settings.

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Association of Fluid Overload with Mortality in Critically-ill Mechanically Ventilated Children

Abstract: Objectives: To study the association of fluid overload with mortality and morbidity in critically-ill mechanically ventilated children.

Cited by 14 publications

References 24 publications

Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a single-center retrospective cohort study

Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a single-center retrospective cohort study

Acute kidney injury in children with cancer admitted in an intensive care unit

Adverse effects of fluid overload in different paediatric age groups

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