Early fluid accumulation in children with shock and ICU mortality: a matched case-control study
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Published on: January 16, 2019
Priya Bhaskar1, Archana V Dhar, Marita Thompson
1Cardiac Intensive Care Unit, Department of Pediatrics, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, 225 East Chicago Avenue, Box 21, Chicago, IL, USA.
Insights
Early fluid overload in children with shock significantly increases intensive care unit (ICU) mortality. The presence, severity, and duration of fluid accumulation are key predictors of adverse outcomes in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Fluid Management in Pediatrics
- Shock States in Children
Background:
- Fluid accumulation is common in critically ill children.
- Early identification of fluid overload is crucial for patient management.
- The impact of early fluid overload on mortality in pediatric shock requires further investigation.
Purpose of the Study:
- To assess the association between early fluid accumulation and mortality in pediatric patients experiencing shock.
- To determine if early fluid overload is an independent predictor of mortality in children with shock.
Main Methods:
- A retrospective matched case-control study was conducted.
- Cases were children with ≥10% body weight fluid accumulation in the initial 3 days of pediatric intensive care unit (ICU) admission for shock.
- Controls were matched for age, illness severity, and organ support needs.
Main Results:
- Early fluid overload was present in 42 cases and 72 matched controls.
- Mortality was significantly higher in cases (26%) compared to controls (6%).
- Presence, severity, and duration of early fluid overload independently predicted increased ICU mortality.
Conclusions:
- Early fluid overload is a significant risk factor for increased ICU mortality in children with shock.
- The degree and length of time of fluid overload correlate with mortality risk.
- Clinical monitoring and management of fluid balance are critical in pediatric shock.
Purpose:
The purpose of this study was to evaluate the association between early fluid accumulation and mortality in children with shock states.
Methods:
We retrospectively reviewed children admitted in shock states to the pediatric intensive care unit (ICU) at a tertiary level children's hospital over a 7-month period. The study was designed as a matched case-control study. Children with early fluid overload, defined as fluid accumulation of ≥10% of admission body weight during the initial 3 days, were designated as the cases. They were compared with matched controls without early fluid accumulation. Cases and controls were matched for age, severity of illness at ICU admission and need for organ support. They were compared with respect to all-cause ICU mortality and other secondary outcomes.
Results:
A total of 114 children (age range 0-17.4 years; N = 42 cases and 72 matched controls) met the study criteria. Mortality rate was 13% (15/114) in this cohort. Multivariable logistic regression analysis identified the presence of early fluid overload [adjusted odds ratio (OR) 9.17, 95% confidence interval (CI) 2.22-55.57], its severity (adjusted OR 1.11, 95% CI 1.05-1.19) and its duration (adjusted OR 1.61, 95% CI 1.21-2.28) as independent predictors of mortality. Cases had higher mortality than the controls (26 vs. 6 %; p 0.003), and this difference remained significant in the matched analysis (37 vs. 3%; p 0.002).
Conclusion:
The presence, severity and duration of early fluid are associated with increased ICU mortality in children admitted to the pediatric ICU in shock states.
