Positive Fluid Balance Is Associated with Higher Mortality and Prolonged Mechanical Ventilation in Pediatric Patients with Acute Lung Injury

Abstract

Introduction. We analyzed a database of 320 pediatric patients with acute lung injury (ALI), to test the hypothesis that positive fluid balance is associated with worse clinical outcomes in children with ALI. Methods. This is a post-hoc analysis of previously collected data. Cumulative fluid balance was analyzed in ml per kilogram per day for the first 72 hours after ALI while in the PICU. The primary outcome was mortality; the secondary outcome was ventilator-free days. Results. Positive fluid balance (in increments of 10 mL/kg/24 h) was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect. These relationships remained unchanged when the subgroup of patients with septic shock (n = 39) were excluded. Conclusions. Persistently positive fluid balance may be deleterious to pediatric patients with ALI. A confirmatory, prospective randomized controlled trial of fluid management in pediatric patients with ALI is warranted.

Fluid resuscitation of shock in children: what, whence and whither?

“…However, this observation along with similar observations from other recent studies ( [12][13][14][15], see Table 1) point to the need to examine the whole pathway-from initial presentation in the ED through to PICU admission-with better clinical tools and better studies.…”

“…This volume will certainly have the potential to impact on fluid overload in the PICU, especially if current ACCM-PALS guidelines are followed (see above, 20-200 mL/kg in the first hour of assessment). Thus while the findings of Bhaskar et al [3]-and for that matter all recent PICU fluid studies [12][13][14][15]-are interesting, they are not conclusive. What is needed now, as Bhaskar et al [3] suggest, are RCTs that better assess the impact of early fluid accumulation on outcome.…”

“…On behalf of all authors, the corresponding author states that there is no other conflict of interest. Flori et al [12] Acute lung injury 320 Positive fluid balance (in 10 mL/kg increments) was associated with increased ventilation days and mortality Arikan et al [13] General PICU population 80 Fluid overload (C15 %) was associated with oxygenation index, ventilation days, and LOS Valentine et al [14] Acute lung injury 168 Increasing fluid balance on day 3 is associated with fewer ventilator-free-days at 28 days Sinitsky et al [15] General PICU population 636 Fluid overload at 48 h was associated with oxygenation index and ventilation days RRT renal replacement therapy, LOS length of stay…”

Shock séptico en la Unidad de Cuidados Intensivos. Terapéutica avanzada, inmunoparálisis y genómica. Estado del arte

“…Asimismo, es conocido el frecuente desarrollo de síndrome de dificultad respiratoria aguda (SDRA) en pacientes sépticos, y está demostrado que la sobrecarga de fluidos está asociada a un peor pronóstico en estos pacientes. Flori et al, 33 en un análisis post hoc, concluyeron que un balance hídrico positivo persistente es dañino en pacientes pediátricos con lesión pulmonar aguda, pues ocasiona una mayor cantidad de días con asistencia respiratoria mecánica y mortalidad, independiente de la magnitud de la falla de oxigenación o la gravedad de la disfunción orgánica. En la misma línea, Arikan et al, 30 demostraron que los pacientes que tenían un mayor porcentaje de sobrecarga de líquidos presentaban un peor índice de oxigenación, mayor duración de la ventilación mecánica y estadía en la UCI, independientes de la edad, género y puntaje de disfunción orgánica.…”

Balance de fluidos y duración de la ventilación mecánica en niños internados en una Unidad de Terapia Intensiva Pediátrica

“…13 E n n i ñ o s , s e m o s t r ó q u e e l balance acumulado de las primeras 72 horas se asociaba a más días de ARM en pacientes con lesión pulmonar aguda 14,15 y en aquellos e n p o s o p e r a t o r i o d e c i r u g í a cardiovascular. 16 También se evidenció que un balance acumulado mayor del 15% del peso corporal se asociaba a un deterioro en la oxigenación y prolongación de ARM.…”