Fluid overload and outcomes in critically ill children: A single center prospective cohort study

Rubio, Franco Díaz; Benfield, Mark R.; Brown, LaTanya; Hayes, Leslie

doi:10.1016/j.jcrc.2017.02.023

Cited by 26 publications

(35 citation statements)

References 32 publications

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“…These studies showed that cumulative fluid overload was a factor that was associated with longer MV duration, but not mortality. [14][15][16] This finding was also observed in our study. Respiratory obstructive diseases, especially bronchiolitis, were the main diagnosis for 60% of survivors, but for none of the patients who died.…”

Section: Discussionsupporting

confidence: 91%

“…After we performed the multivariate regression analysis, we observed that cumulative fluid overload in the first 72 hours of MV (FO% ≥ 10%) was not a factor that was independently associated with mortality. This finding has already been described in similar studies, suggesting that population characteristics, and severity of illness, play a role in determining this outcome . The same phenomenon was observed in PICU patients who required MV due to lower respiratory tract viral infections and the authors reported low mortality rates.…”

Section: Discussionsupporting

confidence: 82%

“…The FO% was different between groups in the first 24 hours, showing that more severely ill patients probably needed more aggressive fluids administration for clinical stabilisation. As reported by other studies, this group required more aggressive MV parameters, used vasoactive drugs at higher doses, and for longer periods, and had a higher need for renal replacement therapy . However, an FO% of ≥10% was not associated with increased mortality risk in these patients.…”

Section: Discussionsupporting

confidence: 68%

“…As reported by other studies, this group required more aggressive MV parameters, used vasoactive drugs at higher doses, and for longer periods, and had a higher need for renal replacement therapy. 6,[14][15][16] However, an FO% of ≥10% was not associated with increased mortality risk in these patients.…”

Section: Re Sultsmentioning

confidence: 75%

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Early fluid overload was associated with prolonged mechanical ventilation and more aggressive parameters in critically ill paediatric patients

Lopes¹,

Eckert

Rocha

et al. 2019

Acta Paediatrica

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Aim We evaluated the influence of early fluid overload on critically ill children admitted to a paediatric intensive care unit by examining mechanical ventilation (MV), mortality, length of stay and renal replacement therapy. Methods This retrospective cohort study covered January 2015 to December 2016 and focused on all episodes of MV support that exceeded 24 hours. The fluid overload percentage (FO%) was calculated daily for the first 72 hours and we estimated its effect on outcomes. Results We included 186 MV episodes in 154 patients. The median age was 13.8 months, with an interquartile range (IQR) of 3.8‐34.0 months, and the mortality rate was 12.4%. The median FO% in the first 72 hours was 8.0% (IQR 3.6%‐11.2%). An FO% of ≥10% was associated with higher ventilatory parameters, namely peak inspiratory pressure (P = .023) and positive end expiratory pressure (P = .003), and renal replacement therapy (P = .02) and higher mortality (8.8% vs 19.7%). In a multivariate Cox regression model, FO ≥ 10% at 72 hours was independently associated with longer MV support, but not mortality (P = .001). Conclusion In a heterogeneous paediatric population given MV, an early cumulative FO of ≥10% was associated with more aggressive ventilatory parameters and prolonged length of MV, but not mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 68%

Section: Re Sultsmentioning

confidence: 75%

See 2 more Smart Citations

Early fluid overload was associated with prolonged mechanical ventilation and more aggressive parameters in critically ill paediatric patients

Lopes¹,

Eckert

Rocha

et al. 2019

Acta Paediatrica

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“…En general, estos mecanismos aún no han sido definidos por completo especialmente en el contexto de pacientes con comorbilidades importantes como inflamación sistémica, infección o daño renal (13,(22)(23)(24)(25).…”

Section: Discussionunclassified

Sobrecarga de fluidos y otros factores de riesgo para mortalidad en pacientes pediátricos de la Unidad de Cuidados Intensivos pediátricos del Hospital de Emergencias Pediátricas, en Lima – Perú

Valdivia¹,

Vivanco²

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Objective: To determine if there is an association between fluid overload and mortality in patients hospitalized in the Pediatric Intensive Care Unit, as well as to define other risk factors for mortality in the same population. Methods: A retrospective cohort study was conducted. We included pediatric patients older than one month and under 18 years of age who were hospitalized in the Pediatric Intensive Care Unit for more than 48 hours during 2016. Demographic and clinical data were recorded. Fluid overload was calculated as [Fluid admitted (L)-Fluid eliminated (L) / weight at admission (Kg)] x 100. Poisson regression analysis was performed to determine the factors associated with mortality. Results: 171 patients were included. The median age was 31 months; the mortality was 8.2%. The Fluid Overload in the surviving population was 7.0% and 11.5% in the non survivors (p <0.05). The adjusted analysis identified Fluid overload, male gender and risk of mortality by Pediatric Index of Mortality 2 (PIM2) as risk factors. Conclusion and recommendations: Fluid overload is associated with mortality in the population of Pediatric Intensive Care Unit studied, it was found that the higher the Fluid Overload the higher the mortality rate. Likewise, it was possible to identify some non-modifiable characteristics with which mortality was increased as younger age, female gender, lower Glasgow scale score and higher Pediatric Index of Mortality 2 value; therefore, it is suggested to pay special attention to fluid management to avoid overload in those patients who comply with these characteristics, since they are more prone to mortality.

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Association Between Fluid Balance and Outcomes in Critically Ill Children

et al. 2018

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IMPORTANCE After initial resuscitation, critically ill children may accumulate fluid and develop fluid overload. Accruing evidence suggests that fluid overload contributes to greater complexity of care and worse outcomes. OBJECTIVE To describe the methods to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children. DATA SOURCES Systematic search of MEDLINE, EMBASE, Cochrane Library, trial registries, and selected gray literature from inception to March 2017. STUDY SELECTION Studies of children admitted to pediatric intensive care units that described fluid balance or fluid overload and reported outcomes of interest were included. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS All stages were conducted independently by 2 reviewers. Data extracted included study characteristics, population, fluid metrics, and outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Narrative description of fluid assessment methods and fluid overload definitions was done. When feasible, pooled analyses were performed using random-effects models. MAIN OUTCOMES AND MEASURES Mortality was the primary outcome. Secondary outcomes included treatment intensity, organ failure, and resource use. RESULTS A total of 44 studies (7507 children) were included in this systematic review and meta-analysis. Of those, 27 (61%) were retrospective cohort studies, 13 (30%) were prospective cohort studies, 3 (7%) were case-control studies, and 1 study (2%) was a secondary analysis of a randomized trial. The proportion of children with fluid overload varied by case mix and fluid overload definition (median, 33%; range, 10%-83%). Fluid overload, however defined, was associated with increased in-hospital mortality (17 studies [n = 2853]; odds ratio [OR], 4.34 [95% CI, 3.01-6.26]; I 2 = 61%). Survivors had lower percentage fluid overload than nonsurvivors (22 studies [n = 2848]; mean difference, −5.62 [95% CI, −7.28 to −3.97]; I 2 = 76%). After adjustment for illness severity, there was a 6% increase in odds of mortality for every 1% increase in percentage fluid overload (11 studies [n = 3200]; adjusted OR, 1.06 [95% CI, 1.03-1.10]; I 2 = 66%). Fluid overload was associated with increased risk for prolonged mechanical ventilation (>48 hours) (3 studies [n = 631]; OR, 2.14 [95% CI, 1.25-3.66]; I 2 = 0%) and acute kidney injury (7 studies [n = 1833]; OR, 2.36 [95% CI, 1.27-4.38]; I 2 = 78%). CONCLUSIONS AND RELEVANCE Fluid overload is common and is associated with substantial morbidity and mortality in critically ill children. Additional research should now ideally focus on interventions aimed to mitigate the potential for harm associated with fluid overload.

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Fluid overload and outcomes in critically ill children: A single center prospective cohort study

Cited by 26 publications

References 32 publications

Early fluid overload was associated with prolonged mechanical ventilation and more aggressive parameters in critically ill paediatric patients

Early fluid overload was associated with prolonged mechanical ventilation and more aggressive parameters in critically ill paediatric patients

Sobrecarga de fluidos y otros factores de riesgo para mortalidad en pacientes pediátricos de la Unidad de Cuidados Intensivos pediátricos del Hospital de Emergencias Pediátricas, en Lima – Perú

Association Between Fluid Balance and Outcomes in Critically Ill Children

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