Fluid overload in children with pediatric acute respiratory distress syndrome: A retrospective cohort study

Leow, Esther Huimin; Wong, Judith Ju‐Ming; Mok, Yee Hui; Hornik, Christoph P.; Ng, Yong H.; Lee, Jan Hau

doi:10.1002/ppul.25720

Cited by 10 publications

(10 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The goal of fluid resuscitation in PARDS is to maintain adequate intravascular volume to maintain optimal Do 2 and end-organ perfusion (56)(57)(58). However, increasing evidence has shown that excessive positive cumulative fluid balance (CFB) and fluid overload have been associated with increased mortality and morbidity (59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71). Observational studies have shown that fluid overload greater than 20% in children with ARDS is associated with increased oxygenation indices, duration of MV, and PICU LOS (60), while other observational studies have identified positive fluid balance at day three to be associated with increased morbidity (61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71).…”

Section: Justificationmentioning

confidence: 99%

“…However, increasing evidence has shown that excessive positive cumulative fluid balance (CFB) and fluid overload have been associated with increased mortality and morbidity (59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71). Observational studies have shown that fluid overload greater than 20% in children with ARDS is associated with increased oxygenation indices, duration of MV, and PICU LOS (60), while other observational studies have identified positive fluid balance at day three to be associated with increased morbidity (61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71). In a quasi-RCT performed in children with PARDS, a preemptive fluid strategy (PFS) bundle was implemented, which aimed at maintaining adequate intravascular volume while minimizing fluid overload.…”

Section: Justificationmentioning

confidence: 99%

See 1 more Smart Citation

Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Valentine

Kudchadkar

Ward

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-five studies were identified for fulltext extraction. Five clinical practice recommendations were generated, related to neuromuscular blockade, nutrition, fluid management, and transfusion. Thirteen good practice statements were generated on the use of sedation, iatrogenic withdrawal syndrome, delirium, sleep management, rehabilitation, and additional information on neuromuscular blockade and nutrition. Three research statements were generated to promote further investigation in nonpulmonary therapies for PARDS. CONCLUSIONS:These recommendations and statements about nonpulmonary treatments in PARDS are intended to promote optimization and consistency of care for patients with PARDS and identify areas of uncertainty requiring further investigation.

show abstract

Section: Justificationmentioning

confidence: 99%

Section: Justificationmentioning

confidence: 99%

Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Valentine

Kudchadkar

Ward

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…The tissue edema, which may co-exist with both hyperand hypovolemic intravascular volume, is considered to be the main cause of adverse effects of fluid overload. This could explain the consistent finding that positive cumulative fluid balance is associated with poor outcomes in both critically ill adults and children (3,7,(14)(15)(16)(17)(18)(19)(20). **Other: switch to enteral feeding (N = 1, 1.2%), not further specified (N = 1, 1.2%).…”

Section: Discussionmentioning

confidence: 97%

Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey

et al. 2022

View full text Add to dashboard Cite

Appropriate fluid management in mechanically ventilated critically ill children remains an important challenge and topic of active discussion in pediatric intensive care medicine. An increasing number of studies show an association between a positive fluid balance or fluid overload and adverse outcomes. However, to date, no international consensus regarding fluid management or removal strategies exists. The aim of this study was to obtain more insight into the current clinical practice of fluid therapy in mechanically ventilated critically ill children. On behalf of the section of cardiovascular dynamics of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) we conducted an anonymous survey among pediatric intensive care unit (PICU) specialists in Europe regarding fluid overload and management. A total of 107 study participants responded to the survey. The vast majority of respondents considers fluid overload to be a common phenomenon in mechanically ventilated children and believes this complication is associated with adverse outcomes, such as mortality and duration of respiratory support. Yet, only 75% of the respondents administers a lower volume of fluids (reduction of 20% of normal intake) to mechanically ventilated critically ill children on admission. During PICU stay, a cumulative fluid balance of more than 5% is considered to be an indication to reduce fluid intake and start diuretic treatment in most respondents. Next to fluid balance calculation, the occurrence of peripheral and/or pulmonary edema (as assessed including by chest radiograph and lung ultrasound) was considered an important clinical sign of fluid overload entailing further therapeutic action. In conclusion, fluid overload in mechanically ventilated critically ill children is considered an important problem among PICU specialists, but there is great heterogeneity in the current clinical practice to avoid this complication. We identify a great need for further prospective and randomized investigation of the effects of (restrictive) fluid strategies in the PICU.

show abstract

“…Peak chronic fluid overload was linked to lower ventilation free days and intensive unit free days, and the rate to peak chronic fluid overload throughout the first 14 days of paediatric acute respiratory distress was linked to death. 7 Findings of another retrospective cohort study revealed that 132 (18%) participants died while non-survivors showed greater overall fluid balance beginning on day 3 as per the unadjusted analyses. A positive overall fluid balance on days 5 through 7 was linked, in a multivariable analysis, to higher mortality.…”

Section: Evidence From Literature For Adverse Effects Of Fluid Overloadmentioning

confidence: 92%

Adverse effects of fluid overload in different paediatric age groups

Althagafi¹,

Qartali²,

Alasmari

et al. 2022

Int J Community Med Public Health

View full text Add to dashboard Cite

Fluid resuscitation is a routine procedure in the treatment of critically ill patients especially in paediatric intensive care units. Fluid overload can result from instability in fluid homeostasis caused by the administration of excessive fluids. Fluid overload can have a wide range of adverse impacts on paediatric critical care patients, including increased mortality risk. Fluid overload increases the length of hospital stay and ventilation time also elevates requirement for renal replacement treatment. The purpose of this research is to review the available information about adverse effects of fluid overload in different paediatric age groups. Literature suggests that fluid overload is associated with significant morbidity and mortality among children. Fluid overload percentage greater than 10% is linked to higher mortality rates among children. Respiratory failure can be triggered by pulmonary alveolar and interstitial edema caused by hypervolemia. Children suffering from acute kidney injury or other renal diseases experience more worsened conditions in presence of fluid overload. Fluid overload can impair organ performance, which can impact disease and fatality. Excessive fluid may alter the efficiency of the heart and perhaps impair cardiac function by considerably moving ventricular compliance to the right on the Frank-Starling curve. The negative effects of fluid overload make patients more susceptible to an elevated risk of morbidity and death even if fluid overload itself is not a direct indicator of mortality. Further research can in aid in developing preventive and management strategies for the fluid balance in paediatric settings.

show abstract

Fluid overload in children with pediatric acute respiratory distress syndrome: A retrospective cohort study

Cited by 10 publications

References 36 publications

Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Nonpulmonary Treatments for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey

Adverse effects of fluid overload in different paediatric age groups

Contact Info

Product

Resources

About