Association of Fluid Overload With Clinical Outcomes in Critically Ill Children With Bronchiolitis: Bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) Study*

Abstract

Objectives: Increasing evidence supports the association of fluid overload with adverse outcomes in different diseases. To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis. Design: Descriptive, prospective, multicenter study. Setting: Sixteen Spanish PICUs. Patients: Severe acute bronchiolitis who required admission from October 2014 to May 2015 were included. Interventions: None. Measurements and Main Results: Total fluid intake and output were prospectively recorded during PICU assistance. Fluid balance was measured at 24, 48, and 72 hours after PICU admission. A total of 262 patients were enrolled; 54.6% were male. Median age was 1 month (interquartile range, 1–3 mo). Patients had a positive fluid balance during the first 4 days of PICU admission, reaching a neutral balance on day 4. A positive balance at 24 hours in patients admitted to the PICU with severe bronchiolitis was related with longer stay in PICU (p < 0.001), longer hospital stay (p < 0.001), longer duration of mechanical ventilation (p = 0.016), and longer duration of noninvasive ventilation (p = 0.0029). Conclusions: Critically ill patients with severe acute bronchiolitis who present a positive balance in the first 24 hours of PICU admission have poorer clinical outcomes with longer PICU and hospital length of stay and duration of invasive and noninvasive mechanical ventilation.

Assessment of the Independent and Synergistic Effects of Fluid Overload and Acute Kidney Injury on Outcomes of Critically Ill Children*

“…While many recent publications indicate excessive fluid accumulation is associated with poor patient outcome in multiple patient populations (4,6,(35)(36)(37), very few attempt to extricate the independent effects of fluid balance from AKI. Physiologically, the two diagnoses of AKI and FO are linked as AKI patients with oliguria are at high risk of fluid accumulation.…”

Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep

“…These three factors taken together certainly amplified the clinical significance. Nevertheless, fluid overload, a major issue in the ICU, is associated with worse clinical outcomes [31]. Interestingly, a good linear correlation was found between total sodium intake and fluid balance (Fig.…”

The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: A Cohort Study

“…Similarly, a large multicenter trial and a study by Ingelse et al (2017) evaluated viral bronchiolitis with early fluid overload. They found the fluid overload to be associated with longer mechanical ventilation duration [ 8 , 9 ] Also, worse outcomes have been described in severe sepsis and ARDS with fluid overload in critically ill children [ 18 , 19 ].…”

“…A randomized controlled trial showed that administering a single dose of furosemide (1 mg/kg) in the emergency department in moderate to severe bronchiolitis did not improve the severity of illness [ 23 ]. Studies have looked at furosemide’s effect on oxygenation and fluid overload; however, there is limited information on the type, dose, mode, or frequency of diuretic used [ 8 , 9 , 24 ].…”

“…It can be administered intermittently or by continuous intravenous infusion. There are only limited studies on the practice of diuretic administration and the effect of fluid overload in children with bronchiolitis [ 8 , 9 ].…”