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Fluid balance in critically ill children with acute lung injury

Stacey L Valentine1, Anil Sapru, Renee A Higgerson

  • 1Critical Care Division, Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, and Department of Anesthesia, Harvard Medical School, Boston, MA 02115, USA. stacey.valentine@childrens.havard.edu

Critical Care Medicine
|July 25, 2012
PubMed

Insights

In pediatric acute lung injury, higher fluid balance on day 3 was linked to fewer ventilator-free days. This supports a conservative fluid strategy in children, similar to adult trial findings.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Clinical Trials

Background:

  • The Fluid and Catheter Treatment Trial (FCT T) demonstrated improved outcomes with conservative fluid management in adults with acute lung injury (ALI).
  • Pediatric ALI trials are challenging due to recruitment difficulties.
  • A Bayesian approach can leverage adult trial data for pediatric studies, potentially reducing patient numbers.

Purpose of the Study:

  • To investigate the association between fluid balance and ventilator-free days in children with ALI.
  • To compare fluid balance patterns in pediatric ALI patients to adults in the FCT T liberal and conservative arms.
  • To inform the design of a Bayesian pediatric trial for fluid management in ALI.

Main Methods:

  • Multicentered retrospective cohort study involving 168 mechanically ventilated children (age ≥1 month to <18 yrs) with ALI.
  • Data collected on fluid intake, output, and net fluid balance (mL/kg) on days 1-7.
  • Multivariable linear regression used to analyze associations, adjusting for clinical factors.

Main Results:

  • Increasing cumulative fluid balance on day 3 was independently associated with fewer ventilator-free days (p=.02).
  • Pediatric patients exhibited higher daily and cumulative fluid balances compared to the FCT T conservative arm (p<.001).
  • Fluid balance patterns in children were similar to those in the FCT T liberal arm.

Conclusions:

  • Elevated fluid balance on day 3 is linked to poorer outcomes (fewer ventilator-free days) in pediatric ALI.
  • Findings suggest a conservative fluid management strategy may benefit children with ALI.
  • Results support conducting a Bayesian trial to confirm these findings and optimize fluid management in pediatric ALI.
Abstract

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