Fluid overload in children with pediatric acute respiratory distress syndrome: A retrospective cohort study

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Medicine
• Nephrology

Background:

• Pediatric Acute Respiratory Syndrome (PARDS) is a critical illness with significant morbidity and mortality.
• Fluid overload (FO) is a common complication in critically ill children, but its long-term impact in PARDS is not fully understood.
• Understanding the relationship between FO and outcomes is crucial for optimizing patient management.

Purpose of the Study:

• To investigate the association between cumulative fluid overload (CFO) up to 14 days post-PARDS diagnosis and pediatric intensive care unit (PICU) mortality.
• To evaluate the impact of CFO on 28-day mechanical ventilation-free days (VFD) and 28-day intensive care unit-free days (IFD).
• To determine if the rate of fluid accumulation influences patient outcomes.

Main Methods:

• Retrospective cohort study of 165 PARDS patients admitted to the PICU between 2009 and 2015.
• Daily FO calculated as (intake-output)/weight at PICU admission; Peak Cumulative FO (CFO) determined up to Day 14.
• Logistic and linear regression models used to analyze associations with mortality, VFD, and IFD, adjusting for covariates like Pediatric Index of Mortality 2 score, PARDS severity, and acute kidney injury (AKI).

Main Results:

• The study included 165 patients with a 45.5% mortality rate.
• Acute kidney injury (AKI) and a higher rate to peak cumulative FO were significantly associated with increased mortality (aOR 3.19 and aOR 1.23, respectively).
• Peak cumulative FO was associated with decreased VFD and IFD.

Conclusions:

• The rate of CFO accumulation within the first 14 days of PARDS is a significant predictor of mortality.
• Peak CFO is independently associated with poorer outcomes, including reduced VFD and IFD.
• These findings underscore the importance of monitoring and managing fluid balance in pediatric patients with PARDS.