Fluid balance and length of mechanical ventilation in children admitted to a single Pediatric Intensive Care Unit

Abstract

Introduction.Associations between cumulative fluid balance and a prolonged duration of assisted mechanical ventilation have been described in adults. The aim of this study was to evaluate whether fluid balance in the first 48 hours of assisted mechanical ventilation initiation was associated with a prolonged duration of this process among children in the Pediatric Intensive Care Unit (PICU). Methods. Retrospective cohort of patients in the PICU of Hospital Italiano de Buenos Aires, between 1/1/2010 and 6/30/2012. Balance was calculated in percentage of body weight; prolonged mechanical ventilation was defined as ≥7 days, and confounders were registered. Univariate and multivariate analyses were performed. Results. Two hundred and forty-nine patients were mechanically ventilated for over 48 hours; 163 were included in the study. Balance during the first 48 hours of mechanical ventilation was 5.7% ± 5.86; 82 patients (50.3%) were on mechanical ventilation for more than 7 days. Age < 4 years old (OR 3.21, 95% CI 1.38-7.48, p 0.007), respiratory disease (OR 4.94, 95% CI 1.51-16.10, p 0.008), septic shock (OR 4.66, 95% CI 1.10-19.65, p 0.036), Pediatric Logistic Organ Dysfunction (PELOD) > 10 (OR 2.44, 95% CI 1.23-4.85, p 0.011), and positive balance > 13% (OR 4.02, 95% CI 1.08-15.02, p 0.038) were associated with prolonged mechanical ventilation. The multivariate model resulted in an OR 2.58, 95% CI: 1.17-5.58, p= 0.018 for PELOD > 10, and an OR 3.7, 95% CI: 0.91-14.94, p= 0.066 for positive balance > 13%. Conclusions. Regarding prolonged mechanical ventilation, the multivariate model showed an independent association with organ dysfunction (PELOD > 10) and a trend towards an association with positive balance > 13%.

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

“…Sinitsky et al [ 11 ] found that diagnostic category was an independent prognostic factor in a study of the correlation between FO at 48 h and respiratory morbidity. Vidal et al [ 14 ] reported that respiratory and septic shock were related to prolonged MV in a study of the correlation between fluid balance and length of MV in children. In this study, the main reason for admission was even statistically significantly related to mortality.…”

“…Extubation failure was defined as the reinstitution of MV within 48 h of extubation. Duration of MV longer than 7 days was concerned based on the effect of prolonged MV on prognosis [ 14 , 15 ].…”

Crystalloid agents used in perioperative infusion therapy in children

“…Анализ констриктивной и либеральной стратегий инфузионной терапии показал, что первый вариант улучшал функцию легких, сокращал продолжительность механической вентиляции легких и интенсивной терапии без увеличения количества нелегочных осложнений, сокращал частоту проявления острой почечной травмы у пациентов с острым повреждением легких и острым респираторным дистресс-синдромом [15][16][17]. Метаанализ Silversides J.…”

Non-cardio respiratory monitoring of mechanically ventilated critically ill patients

“…15 Positive fluid balance has shown to have a trend towards prolonged mechanical ventilation. 16 It has been found that a negative fluid balance of < 500 ml achieved in any of the first 3 days of septic shock is a good independent predictor of survival in patients with septic shock. 17 The higher cumulative fluid balance at third day after ICU admission was independently associated with an increase mortality hazard in sepsis patients, but not the higher fluid balance in the first 24 hours.…”