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

Abstract

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.

Epidemiology, risk factors and outcomes of prolonged mechanical ventilation with different cut-points in a PICU

“…High DP, more than 15 cm H 2 O, in acute hypoxemic respiratory failure children was independently associated with There is currently no study of DP in PMV. The median maximum DP in our study was 16 cm H 2 O (IQR: 13-20) and DP tended to be greater when comparing PMV > 30 days with PMV > 14-30 days [17 (14-20) vs. 15 (13)(14)(15)(16)(17)(18), P = 0.09] which supports previous studies (17, 21). Although deaths had a significantly higher median maximum DP than survivors [19 (16)(17)(18)(19)(20)(21)(22) vs. 15 (12)(13)(14)(15)(16)(17)(18) cm H 2 O, P < 0.001], it was not an independent predictor of mortality after multivariate analysis (even with a cutoff of 17 cm H 2 O).…”

“…The median maximum DP in our study was 16 cm H 2 O (IQR: 13-20) and DP tended to be greater when comparing PMV > 30 days with PMV > 14-30 days [17 (14-20) vs. 15 (13)(14)(15)(16)(17)(18), P = 0.09] which supports previous studies (17, 21). Although deaths had a significantly higher median maximum DP than survivors [19 (16)(17)(18)(19)(20)(21)(22) vs. 15 (12)(13)(14)(15)(16)(17)(18) cm H 2 O, P < 0.001], it was not an independent predictor of mortality after multivariate analysis (even with a cutoff of 17 cm H 2 O). Several studies reported an association between fluid accumulation and MV duration, PICU LOS and mortality rate (18)(19)(20).…”

“…Additionally, our analysis revealed that individuals who died had a significantly higher incidence of cardiac disease as a main diagnosis (27.3% vs. 11.1%, P = 0.03), as well as higher rates of cardiovascular (30.3% vs. 12.4%, P = 0.02) and gastrointestinal diseases (24.2% vs. 8.6%, P = 0.03) as underlying diseases. They also had a higher median maximum DP [19 (16)(17)(18)(19)(20)(21)(22) vs. 15 (12-18) cm H 2 O, P < 0.001] compared to the survivors. Our findings suggest that patients with cardiac disease are more vulnerable to changes in fluid and electrolyte balance, and poor cardiac function can worsen respiratory complications such as atelectasis or pulmonary edema, which can ultimately lead to death.…”

“…A comparison between survivors (n = 81/114, 71.1%) and deaths (n = 33/114, 28.9%) is shown in Supplementary material Tables S5-S7. Deaths had higher rates of cardiac disease as a main diagnosis (27.3% vs. 11.1%, P = 0.03), cardiovascular diseases (30.3% vs. 12.4%, P = 0.02) and gastrointestinal diseases (24.2% vs. 8.6%, P = 0.03) as underlying diseases, 3rd degree PEM (54.6% vs. 16.1%, P < 0.001), inotropic or vasopressor usage (78.8% vs. 50.6%, P = 0.006), muscle relaxant usage (75.8% vs. 38.3%, P < 0.001), median maximum VIS in the first 72 h [20 (7-47) vs. 2.8 (0-15), P < 0.001], median duration of muscle relaxant use [10 (5-15) vs. 3 (2-5) days, P < 0.001], median maximum DP [19 (16)(17)(18)(19)(20)(21)(22) vs. 15 (12)(13)(14)(15)(16)(17)(18)…”

“…The incidence where PMV > 30 days was 30% (15). The published risk factors associated with PMV were younger age, especially <1 year old, chronic comorbidities, prematurity, a higher PIM-3 score, inotropic or vasopressors usage, higher driving pressure and fluid overload (14,(16)(17)(18)(19)(20)(21).…”