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Early Fluid Overload Prolongs Mechanical Ventilation in Children With Viral-Lower Respiratory Tract Disease
Sarah A Ingelse1, Hanke M G Wiegers, Job C Calis
1All authors: Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Insights
Early fluid overload in young children with viral-lower respiratory tract disease is linked to longer mechanical ventilation. Avoiding fluid overload may reduce ventilation duration in these critically ill patients.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Respiratory Medicine
Background:
- Viral-lower respiratory tract disease is a significant cause of morbidity in young children globally.
- Acute respiratory failure in children often requires pediatric intensive care unit (PICU) admission and mechanical ventilation.
- Early fluid overload is a known risk factor for adverse outcomes in critically ill patients, but its impact on children with viral-lower respiratory tract disease is less understood.
Purpose of the Study:
- To investigate the relationship between early fluid overload and adverse outcomes in mechanically ventilated children with viral-lower respiratory tract disease.
- To determine if fluid overload predicts prolonged mechanical ventilation or reduced oxygen saturation in this pediatric population.
Main Methods:
- A retrospective cohort study was conducted.
- Data were collected from 135 children under 2 years old admitted to a tertiary referral PICU between 2008 and 2014.
- Cumulative fluid balance on day 3 of mechanical ventilation was analyzed against ventilation duration and oxygen saturation index using regression analysis.
Main Results:
- The mean cumulative fluid balance on day 3 was +97.9 mL/kg.
- Higher cumulative fluid balance on day 3 was independently associated with a longer duration of mechanical ventilation (p=0.048).
- No significant association was found between fluid status and oxygen saturation index.
Conclusions:
- Early fluid overload is an independent predictor of prolonged mechanical ventilation in young children with viral-lower respiratory tract disease.
- Avoiding early fluid overload may be a therapeutic target to shorten mechanical ventilation duration in these children.
- Further prospective clinical trials are recommended to validate these findings.
Objectives:
Viral-lower respiratory tract disease is common in young children worldwide and is associated with high morbidity. Acute respiratory failure due to viral-lower respiratory tract disease necessitates PICU admission for mechanical ventilation. In critically ill patients in PICU settings, early fluid overload is common and associated with adverse outcomes such as prolonged mechanical ventilation and increased mortality. It is unclear, however, if this also applies to young children with viral-lower respiratory tract disease induced acute respiratory failure. In this study, we aimed to investigate the relation of early fluid overload with adverse outcomes in mechanically ventilated children with viral-lower respiratory tract disease in a retrospective dataset.
Design:
Retrospective cohort study.
Setting:
Single, tertiary referral PICU.
Patients:
One hundred thirty-five children (< 2 yr old) with viral-lower respiratory tract disease requiring mechanical ventilation admitted to the PICU of the Academic Medical Center, Amsterdam between 2008 and 2014.
Interventions:
None.
Measurements And Main Results:
The cumulative fluid balance on day 3 of mechanical ventilation was compared against duration of mechanical ventilation (primary outcome) and daily mean oxygen saturation index (secondary outcome), using uni- and multivariable linear regression. In 132 children, the mean cumulative fluid balance on day 3 was + 97.9 (49.2) mL/kg. Higher cumulative fluid balance on day 3 was associated with a longer duration of mechanical ventilation in multivariable linear regression (β = 0.166; p = 0.048). No association was found between the fluid status and oxygen saturation index during the period of mechanical ventilation.
Conclusions:
Early fluid overload is an independent predictor of prolonged mechanical ventilation in young children with viral-lower respiratory tract disease. This study suggests that avoiding early fluid overload is a potential target to reduce duration of mechanical ventilation in these children. Prospective testing in a clinical trial is warranted to support this hypothesis.
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