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Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis
Published on: August 17, 2022
Timing of Fluid Overload and Association With Patient Outcome
Lisa Lima1, Shina Menon2,3, Stuart L Goldstein2,4
1Department of Pediatrics, Division of Critical Care Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
Insights
The timing of fluid overload in pediatric intensive care units (PICUs) significantly impacts patient outcomes. Delayed fluid accumulation after 48 hours is linked to increased mortality and longer hospital stays, highlighting the importance of fluid management timing.
Area of Science:
- Pediatric critical care medicine
- Fluid balance management
- Patient outcomes research
Background:
- Fluid overload is a common complication in critically ill children.
- The timing of fluid accumulation may influence patient outcomes.
Purpose of the Study:
- To investigate the association between the timing of excess fluid accumulation (fluid overload) and adverse patient outcomes in a pediatric intensive care unit (PICU).
Main Methods:
- Secondary analysis of prospectively collected data from 177 children (3 months to 25 years) admitted to a PICU.
- Patients were categorized based on the timing of peak fluid overload (within 48 hours vs. after 48 hours of ICU admission) and the timing of achieving a negative daily fluid balance.
Main Results:
- Peak fluid overload after 48 hours of ICU admission was associated with longer ICU and hospital stays, and a significantly increased risk of mortality (13% vs. 2%).
- Achieving a negative daily fluid balance later (Day 3-7) was linked to longer mechanical ventilation duration and increased hospital and ICU lengths of stay compared to earlier negative balance (Day 0-2).
Conclusions:
- The timing of fluid accumulation, not just the peak percentage, is a critical factor associated with patient outcomes in the PICU.
- Further research is warranted to explore the relationship between the timing of fluid accumulation and patient outcomes.
Objectives:
To determine if the timing of excess fluid accumulation (fluid overload) is associated with adverse patient outcomes.
Design:
Secondary analysis of a prospectively collected dataset.
Setting:
PICU of a tertiary care hospital.
Patients:
Children 3 months to 25 years old admitted to the PICU with expected length of stay greater than or equal to 48 hours.
Interventions:
Patients were dichotomized by time of peak overload: peak fluid overload from ICU admission (Day0) to 48 hours (Day3-7) and peak fluid overload value after 48 hours of ICU admission, as well as time of first-time negative daily fluid balance: net fluid out greater than net fluid in for that 24-hour period.
Measurements And Main Results:
There were 177 patients who met inclusion criteria, 92 (52%) male, with an overall mortality rate of 7% (n = 12). There were no differences in severity of illness scores or fluid overload on Day0 between peak fluid overload from ICU admission (Day0) to 48 hours (Day3-7) (n = 97; 55%) and peak fluid overload value after 48 hours of ICU admission (n = 80; 45%) groups. Peak fluid overload value after 48 hours of ICU admission was associated with a longer median ICU course (8 [4-15] vs 4 d [3-8 d]; p ≤ 0.001], hospital length of stay (18 [10-38) vs 12 [8-24]; p = 0.01], and increased risk of mortality (n = 10 [13%] vs 2 [2%]; χ2 = 7.6; p = 0.006]. ICU length of stay was also longer in the peak fluid overload value after 48 hours of ICU admission group when only patients with at least 7 days of ICU stay were analyzed (p = 0.02). Timing of negative fluid balance was also correlated with outcome. Compared with Day0-2, a negative daily fluid balance on Day3-7 was associated with increased length of mechanical ventilation (3 [1-7] vs 1 d [2-10 d]; p ≤ 0.001) and increased hospital (17 [10-35] vs 11 d [7-26 d]; p = 0.006) and ICU (7 [4-13] vs 4 d [3-7 d]; p ≤ 0.001) length of stay compared with a negative fluid balance between Day0-2.
Conclusions:
Our results show timing of fluid accumulation not just peak percentage accumulated is associated with patient outcome. Further exploration of the association between time and fluid accumulation is warranted.
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