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Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis
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Positive Fluid Balance is Associated with Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock

Judith Jm Wong1, Stephanie X Ho, Alpha Omega Cj Lee

  • 1Children's Intensive Care Unit, Department of Paediatric Subspecialities, KK Women's and Children's Hospital, Singapore.

Annals of the Academy of Medicine, Singapore
|November 19, 2019
PubMed

Insights

Excess fluid in critically ill children with sepsis is linked to higher mortality. Higher percentage fluid overload (%FO) in the paediatric intensive care unit (PICU) independently predicts worse outcomes, including death.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pediatric Sepsis Research
  • Fluid Management in Pediatrics

Background:

  • Excess fluid accumulation poses potential risks to critically ill children.
  • Severe sepsis and septic shock are significant causes of pediatric intensive care unit (PICU) admissions.

Purpose of the Study:

  • To investigate the association between percentage fluid overload (%FO) and mortality in pediatric patients with severe sepsis and septic shock.
  • To evaluate the impact of %FO on key secondary outcomes such as ventilator-free days (VFD), intensive care unit-free days (IFD), and inotrope-free days (InoFD).

Main Methods:

  • Retrospective analysis of 116 pediatric patients with severe sepsis/septic shock admitted to the PICU.
  • %FO calculated daily as (total input - total output / admission weight) × 100.
  • Multivariate analysis adjusted for comorbidities, PIM 2 score, and multiorgan dysfunction to assess cumulative %FO over 5 days.

Main Results:

  • A total of 116 patients were analyzed, with a 28.4% mortality rate.
  • Higher cumulative %FO over 5 days was observed in non-survivors (15.1%) compared to survivors (3.6%) (P < 0.001).
  • Cumulative %FO was independently associated with increased PICU mortality (aOR 1.08) and decreased VFD, IFD, and InoFD.

Conclusions:

  • Cumulative %FO within the first 5 days of PICU admission is a significant independent predictor of poor outcomes in children with severe sepsis and septic shock.
  • Findings suggest a potential benefit of fluid restriction strategies in this patient population.
  • Further research is warranted to explore the efficacy of restrictive fluid management.
Abstract

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