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

Abstract

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.

Paediatric dengue shock syndrome and acute respiratory failure: a single-centre retrospective study

“…Our findings are consistent with other studies that showed that higher fluid accumulation, Open access ranging from more than 10% to 20%, is associated with a higher proportion of patients requiring MV and a longer duration of MV. [24][25][26][27][28] Variable aetiologies of ARF have been reported to concomitantly occur with features of severe dengue. These include significant pleural effusion from fluid leakage, pulmonary haemorrhage from thrombocytopenia and coagulopathy, transfusion-related acute lung injury from massive blood product transfusions, acute lung injury/ARDS and from hepatic dysfunction, and decreased level of consciousness and airway protective reflexes in dengue encephalopathy.…”

Ventilator-associated events: From surveillance to optimizing management

“…Fluid overload, which includes pulmonary edema, accounts for up to 48% of VAE. [ 24 ] Fluid imbalance is associated with prolonged time of MV in adults [ 25 , 26 ] and children, [ 27 , 28 ] and it has been established as a risk factor for VAE. [ 2 ] The inclusion of clinically relevant pulmonary edema in the VAE algorithm is one of the greatest differences between the VAP and VAE algorithms, which is relevant considering the latter highlights strategies aimed at improving fluid balance, such as parsimonious fluid resuscitation and initiation of diuretics when indicated.…”

Factors to be Considered in Advancing Pediatric Critical Care Across the World

“…We now understand that less aggressive blood transfusion [40] or glycaemic control [41] and conservative use of parenteral nutrition [42] are not associated with worse outcomes. More conservative use of oxygen therapy [43][44][45][46][47][48], fluid administration [49][50][51][52][53], vascular access, antibiotic therapies [54] all have evidence to support them. There is growing awareness to titrate all of these therapies to the needs of specific patients; to specific and appropriate endpoints and goals; and with awareness of the associated adverse effects of all these interventions.…”