Continuous renal replacement therapy in children: fluid overload does not always predict mortality

Galasso, Lara De; Emma, Francesco; Picca, Stefano; Nardo, Matteo Di; Rossetti, Emanuele; Guzzo, Isabella

doi:10.1007/s00467-015-3248-6

Cited by 37 publications

(42 citation statements)

References 32 publications

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“…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%

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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: 68%

“…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. These studies showed that cumulative fluid overload was a factor that was associated with longer MV duration, but not mortality …”

Section: Discussionmentioning

confidence: 98%

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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“…The SSCG 2012 suggested consideration of the use of diuretics and RRT to avoid greater than 10% total body weight fluid overload [3] based mainly on a single-center retrospective study [101]. Unfortunately, this suggestion, especially the threshold value of fluid overload, has not been validated well among septic children yet [102–104]. The efficacy of PE in pediatric sepsis is also ambiguous.…”

Section: Adjunct Therapiesmentioning

confidence: 99%

Update on pediatric sepsis: a review

Kawasaki

2017

j intensive care

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BackgroundSepsis is one of the leading causes of mortality among children worldwide. Unfortunately, however, reliable evidence was insufficient in pediatric sepsis and many aspects in clinical practice actually depend on expert consensus and some evidence in adult sepsis. More recent findings have given us deep insights into pediatric sepsis since the publication of the Surviving Sepsis Campaign guidelines 2012.Main textNew knowledge was added regarding the hemodynamic management and the timely use of antimicrobials. Quality improvement initiatives of pediatric “sepsis bundles” were reported to be successful in clinical outcomes by several centers. Moreover, a recently published global epidemiologic study (the SPROUT study) did not only reveal the demographics, therapeutic interventions, and prognostic outcomes but also elucidated the inappropriateness of the current definition of pediatric sepsis.ConclusionsWith these updated knowledge, the management of pediatric sepsis would be expected to make further progress. In addition, it is meaningful that the fundamental data on which future research should be based were established through the SPROUT study.

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“…(11,13) In developed countries, the most frequent risk factors for AKI are cardiac surgery, acute tubular necrosis, sepsis, and the use of nephrotoxic drugs. (14) …”

Section: Pathophysiologymentioning

confidence: 99%

“…One of the associated risk factors is the FO%; an FO% that reaches 10 to 20% has been shown to be an independent predictive factor for mortality. (14) …”

Section: Pathophysiologymentioning

confidence: 99%

Fluid overload in children undergoing mechanical ventilation

Lopes¹,

Piva²

2017

Revista Brasileira De Terapia Intensiva

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Patients admitted to an intensive care unit are prone to cumulated fluid overload and receive intravenous volumes through the aggressive resuscitation recommended for septic shock treatment, as well as other fluid sources related to medications and nutritional support. The liberal liquid supply strategy has been associated with higher morbidity and mortality. Although there are few prospective pediatric studies, new strategies are being proposed. This non-systematic review discusses the pathophysiology of fluid overload, its consequences, and the available therapeutic strategies. During systemic inflammatory response syndrome, the endothelial glycocalyx is damaged, favoring fluid extravasation and resulting in interstitial edema. Extravasation to the third space results in longer mechanical ventilation, a greater need for renal replacement therapy, and longer intensive care unit and hospital stays, among other changes. Proper hemodynamic monitoring, as well as cautious infusion of fluids, can minimize these damages. Once cumulative fluid overload is established, treatment with long-term use of loop diuretics may lead to resistance to these medications. Strategies that can reduce intensive care unit morbidity and mortality include the early use of vasopressors (norepinephrine) to improve cardiac output and renal perfusion, the use of a combination of diuretics and aminophylline to induce diuresis, and the use of sedation and early mobilization protocols.

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Continuous renal replacement therapy in children: fluid overload does not always predict mortality

Abstract: In children treated with CRRT the underlying diagnosis and severity of illness are independent risk factors for mortality. The degree of FO is a negative predictor only in patients with milder disease.

Cited by 37 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

Update on pediatric sepsis: a review

Fluid overload in children undergoing mechanical ventilation

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