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Extent, risk factors, and outcome of fluid overload after pediatric heart surgery*
Jade Seguin1, Benjamin Albright, Laura Vertullo
11Department of Pediatrics, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada. 2Department of Cardiac Surgery, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada.
Insights
Fluid overload in pediatric cardiac surgery patients occurs early and is linked to longer PICU stays and mechanical ventilation. Further trials are needed to confirm if fluid management can improve outcomes.
Area of Science:
- Pediatric critical care medicine
- Pediatric cardiac surgery
- Fluid management in intensive care
Background:
- Fluid overload is a known risk factor for poor outcomes in pediatric intensive care unit (PICU) patients.
- Limited data exists on fluid overload specifically in children undergoing cardiac surgery.
- Understanding fluid overload in this population is crucial for improving patient care and outcomes.
Purpose of the Study:
- To describe the incidence and patterns of fluid overload in children after cardiac surgery.
- To identify risk factors associated with increased fluid overload.
- To determine if fluid overload predicts longer PICU length of stay, mechanical ventilation duration, and impaired lung function (oxygenation index).
Main Methods:
- Retrospective cohort study of 193 patients (≤18 years) undergoing cardiac surgery.
- Fluid overload calculated as cumulative fluid overload percentage ([(total fluid in - out L)/admission weight kg] × 100).
- Risk factors analyzed using stepwise linear regression; outcome associations evaluated with Cox regression and generalized estimating equations.
Main Results:
- Peak fluid overload averaged 7.4% ± 11.2%, occurring by PICU day 2.
- Risk factors for higher day 2 fluid overload included lack of prior cardiac surgery, cyanotic heart disease, and early postoperative fluids.
- Day 2 fluid overload independently predicted longer PICU length of stay and mechanical ventilation duration.
Conclusions:
- Fluid overload is an early event following pediatric cardiac surgery.
- Early fluid overload is associated with prolonged PICU stay and mechanical ventilation.
- Further research, including fluid overload avoidance trials, is warranted to establish causality and guide interventions.
Objectives:
Fluid overload is associated with poor PICU outcomes in different populations. Little is known about fluid overload in children undergoing cardiac surgery. We described fluid overload after cardiac surgery, identified risk factors of worse fluid overload and also determined if fluid overload predicts longer length of PICU stay, prolonged mechanical ventilation (length of ventilation) and worse lung function as estimated by the oxygenation index.
Design:
Retrospective cohort study.
Setting:
Montreal Children's Hospital PICU, Montreal, Canada.
Patients:
Patients 18 years or younger undergoing cardiac surgery (2005-2007).
Interventions:
None.
Measurements And Main Results:
Cumulative fluid overload % was calculated as [(total fluid in - out in L)/admission weight (kg) × 100] and expressed as PICU peak cumulative fluid overload % throughout admission and PICU day 2 cumulative fluid overload %. Primary outcomes were length of stay and length of ventilation. The secondary outcome was oxygenation index. Fluid overload risk factors were evaluated using stepwise linear regression. Fluid overload-outcome relations were evaluated using stepwise Cox regression (length of stay, length of ventilation) and generalized estimating equations (daily PICU cumulative fluid overload % and oxygenation index repeated measures). There were 193 eligible surgeries. Peak cumulative fluid overload % was 7.4% ± 11.2%. Fluid overload peaked on PICU day 2. Lack of past cardiac surgery (p = 0.04), cyanotic heart disease (p = 0.03), and early postoperative fluids (p = 0.0001) was independently associated with higher day 2 fluid overload %. Day 2 fluid overload % predicted longer length of stay (adjusted hazard ratio, 0.95; 95% CI, 0.92-0.99; p = 0.009) and length of ventilation (adjusted hazard ratio, 0.97; 95% CI, 0.94-0.99; p = 0.03). In patients without cyanotic heart disease, worse daily fluid overload % predicted worse daily oxygenation index.
Conclusion:
Fluid overload occurs early after cardiac surgery and is associated with prolonged PICU length of stay and ventilation. Future fluid overload avoidance trials may confirm or refute a true fluid overload-outcome causative association.
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