Prospective Cohort Study on Cumulative Fluid Balance and Outcome in Critically Ill Children Using a Restrictive Fluid Protocol

Rameshkumar, Ramachandran; Chidambaram, Muthu; Singanamalla, Bhanudeep; Krishnamurthy, Kandamaran; Sheriff, Abraar; Selvan, Tamil; Mahadevan, Subramanian

doi:10.1007/s12098-021-03788-4

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…However, a recent study found that in critically sick infants, cumulative fluid balance up to 3% in the first 7 days was not significantly related with death and morbidity [25] . The authors carefully monitored fluid balance while employing a limited fluid approach.…”

Section: Discussionmentioning

confidence: 93%

Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit

Mahmoud¹,

Abdelatif²,

Bakheet³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Pediatric intensive care unit (PICU) has improved the outcome of children in developed countries. However, little is known about the PICU outcomes in resource-limited settings. Objective: This study was aimed to investigate outcomes predictors at an Egyptian PICU. Patients and Methods: This prospective study was conducted at PICU of Sohag University Hospital from March 2018 to June 2020. Collected data included patients' demographics, clinical, laboratory parameters, severity of illness scores, management, and length of stay in days. Main outcomes were PICU mortality and functional status deterioration (assessed by functional status scale) on discharge and after 6 months. Outcome predictors were evaluated by multivariable logistic regression analysis.Results: This study included 451 patients. The median (IQR) age was 7 (3 -24) months. Sepsis was the major diagnosis (60.1%). The PICU mortality rate was 37.9%. Of survivors, 18.9% developed new disability at PICU discharge. At 6 months only 7.5% had a residual new disability. Multivariable analysis showed that presence of multiorgan dysfunction (AOR=44.9, 95%CI (15-134.3), p <0.001), acute kidney injury (AOR = 11.6, 95%CI (1.82-74.2), p = 0.009), need for prolonged intravenous fluid administration (AOR = 1.2, 95%CI (1.1-1.3), p = 0.005), vasoactive inotropic support on first day of admission(AOR = 1, 95%CI (1-1.1), p = 0.038) and antibiotic escalation (AOR = 4.6, 95%CI (1.5-14.1), p =0.007) contributed to higher mortality outcome. Conclusion:It could be concluded that the PICU mortality was high while the rate of developing functional deterioration was relatively low. Factors related to sepsis-induced organ dysfunction and its treatment were associated with the poor outcomes.

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Section: Discussionmentioning

confidence: 93%

Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit

Mahmoud¹,

Abdelatif²,

Bakheet³

et al. 2023

The Egyptian Journal of Hospital Medicine

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“…The criteria for fluid overload used by the authors are at variance with earlier reports [1]. Also, the authors had a restrictive fluid and active deresuscitation approach, and maximal positive fluid balance in the cohort was only 3.1% [mean (SD): 1.52 (0.67) in group with positive fluid balance] [3].…”

mentioning

confidence: 75%

“…In the context of the current study [3], this implies that children classified as having 'positive fluid balance' may not practically have had any overload. As the children did not develop fluid overload, conclusions regarding effect of fluid overload on outcomes should not be made from this study.…”

mentioning

confidence: 80%

“…In the study by Rameshkumar et al in the Journal, impact of cumulative positive fluid balance during the first 7 d on various outcomes was assessed in a developing world PICU setting practising restrictive fluid protocol [3]. They did not observe an association of a positive fluid balance during the first 7 d with mortality, organ dysfunction, acute kidney injury or need for renal replacement therapy.…”

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confidence: 98%

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Fluid Overload in Critically Ill Children: More Questions Than Answers!

Dhochak

Lodha

2022

Indian J Pediatr

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“…was calculated daily [% F.O. = (total fluid intake in liters − total fluid output in liters ÷ admission weight in kilograms) × 100] [ 13 , 14 ]. All discharged patients were followed up for 30 days.…”

Section: Methodsmentioning

confidence: 99%

High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial

Kandasamy,

Rameshkumar,

Sangaralingam

et al. 2024

Intensive Care Med. Paediatr. Neonatal

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Objective To compare the effectiveness of early high-flow nasal cannula (HFNC) and low-flow oxygen support (LFOS) in children under 5 years with acute hypoxemic respiratory failure (AHRF) due to severe community-acquired pneumonia in low-middle-income countries. Methods An open-label randomized clinical trial enrolled children aged 2–59 months with AHRF due to severe community-acquired pneumonia and randomized into HFNC and LFOS. In the LFOS group, the patient received cold wall oxygen humidified by bubbling through sterile water administered through simple nasal prongs at a fixed flow rate of 2 L/min. In the HFNC group, the patient received humidified, heated (37 °C), high-flow oxygen at a flow rate assigned based on weight range, with a titratable oxygen fraction. The primary outcome was treatment failure in 72 h (escalating the respiratory support method using any modality other than primary intervention). Results Data was analyzed intention-to-treat (HFNC = 124; LFOS = 120). Median (IQR) age was 12 (6–20) and 11 (6–27) months, respectively. Treatment failure occurred in a significantly lower proportion in the HFNC group (7.3%, n = 9/124) as compared to the LFOS group (20%, n = 24/120) (relative risk = 0.36, 95% CI 0.18 to 0.75; p = 0.004; adjusted hazard ratio 0.34, 95% CI 0.16 to 0.73; p = 0.006). The intubation rate was significantly lower in the HFNC group (7.3%, n = 9/124 vs. 16.7%, n = 20/120; relative risk = 0.44, 95% CI 0.21 to 0.92, p = 0.023). There were no significant differences noted in other secondary outcomes. No mortality occurred. Conclusion High-flow nasal cannula oxygen therapy used as early respiratory support in children under 5 years with acute hypoxemic respiratory failure due to severe community-acquired pneumonia was associated with significantly lower treatment failure compared with standard low-flow oxygen support. Trial registration CTRI/2016/04/006788. Registered 01 April 2016, https://ctri.nic.in/Clinicaltrials/advsearch.php.

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Prospective Cohort Study on Cumulative Fluid Balance and Outcome in Critically Ill Children Using a Restrictive Fluid Protocol

Cited by 6 publications

References 30 publications

Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit

Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit

Fluid Overload in Critically Ill Children: More Questions Than Answers!

High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial

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