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Published on: January 12, 2024
Fluid Overload Is Associated With Higher Mortality and Morbidity in Pediatric Patients Undergoing Cardiac Surgery
Daniel J Lex1, Roland Tóth, Nikoletta R Czobor
11School of PhD Studies, Semmelweis University, Budapest, Hungary. 2Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia. 3Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 4Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 5Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
Insights
Early fluid overload in pediatric cardiac surgery patients increases mortality and morbidity. Key risk factors include kidney dysfunction, hemodynamic instability, and significant blood loss during surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Nephrology
Background:
- Fluid overload is a frequent complication following pediatric cardiac surgery.
- It is associated with increased mortality and morbidity in this vulnerable population.
Purpose of the Study:
- To investigate the risk factors contributing to early postoperative fluid overload.
- To examine the relationship between fluid overload and adverse patient outcomes.
Main Methods:
- Secondary analysis of prospectively collected data from pediatric patients (<18 years) undergoing open-heart surgery.
- Data collected between 2004 and 2008 at a tertiary national cardiac center.
- Fluid overload calculated as fluid balance (L)/weight (kg) × 100 within the first 72 postoperative hours.
Main Results:
- Higher fluid overload on the day of surgery independently predicted in-hospital mortality (aOR 1.14) and low cardiac output syndrome (aOR 1.21).
- Risk factors for >5% fluid overload included elevated serum creatinine, high vasoactive-inotropic scores, and greater blood loss.
- Over 10% fluid overload was observed in 2.1% of patients.
Conclusions:
- Early postoperative fluid overload is a significant predictor of adverse outcomes, including mortality and morbidity.
- Underlying kidney dysfunction, hemodynamic instability, and surgical blood loss are key risk factors for developing fluid overload.
Objectives:
Fluid overload after pediatric cardiac surgery is common and has been shown to increase both mortality and morbidity. This study explores the risk factors of early postoperative fluid overload and its relationship with adverse outcomes.
Design:
Secondary analysis of the prospectively collected data of children undergoing open-heart surgery between 2004 and 2008.
Setting:
Tertiary national cardiac center.
Patients:
One thousand five hundred twenty consecutive pediatric patients (<18 years old) were included in the analyses.
Interventions:
None.
Measurements And Main Results:
In the first 72 hours of the postoperative period, the daily fluid balance was calculated as milliliter per kilogram and the daily fluid overload was calculated as fluid balance (L)/weight (kg) × 100. The primary endpoint was in-hospital mortality; the secondary outcomes were low cardiac output syndrome and prolonged mechanical ventilation. One thousand three hundred and sixty-seven patients (89.9%) had a cumulative fluid overload below 5%; 120 patients (7.8%), between 5% and 10%; and 33 patients (2.1%), above 10%. After multivariable analysis, higher fluid overload on the day of the surgery was independently associated with mortality (adjusted odds ratio, 1.14; 95% CI, 1.008-1.303; p = 0.041) and low cardiac output syndrome (adjusted odds ratio, 1.21; 95% CI, 1.12-1.30; p = 0.001). Higher maximum serum creatinine levels (adjusted odds ratio, 1.01; 95% CI, 1.003-1.021; p = 0.009), maximum vasoactive-inotropic scores (adjusted odds ratio, 1.01; 95% CI, 1.005-1.029; p = 0.042), and higher blood loss on the day of the surgery (adjusted odds ratio, 1.01; 95% CI, 1.004-1.025; p = 0.015) were associated with a higher risk of fluid overload that was greater than 5%.
Conclusions:
Fluid overload in the early postoperative period was associated with higher mortality and morbidity. Risk factors for fluid overload include underlying kidney dysfunction, hemodynamic instability, and higher blood loss on the day of the surgery.
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