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Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a

Xiangmei Kong1, Yueniu Zhu1, Xiaodong Zhu2

  • 1Department of Pediatric Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.

BMC Pediatrics
|October 27, 2021
PubMed

Insights

Fluid overload (FO) in children on mechanical ventilation (MV) did not significantly correlate with mortality. However, a percentage FO greater than 20% was an independent risk factor for in-hospital death in critically ill pediatric patients.

Area of Science:

  • Pediatric Intensive Care
  • Critical Care Medicine
  • Mechanical Ventilation

Background:

  • Positive fluid overload (FO) is a potential adverse effect in critically ill patients.
  • The relationship between early FO and in-hospital mortality in children requiring mechanical ventilation (MV) needs further investigation.

Purpose of the Study:

  • To retrospectively analyze the association between early fluid overload and in-hospital mortality in pediatric intensive care unit (PICU) patients on MV.
  • To determine if specific thresholds of percentage FO (%FO) are linked to increased mortality.

Main Methods:

  • Retrospective analysis of 309 children (28 days to 16 years) receiving invasive MV for over 48 hours.
  • Early FO was defined as FO within the first 3 days of MV.
  • Patients were grouped based on early FO and survival to assess associations with mortality, including %FO > 10% and %FO > 20%.

Main Results:

  • Overall in-hospital mortality was 26.2% (81/309).
  • No significant differences in mortality were found among different FO groups or in early FO between survivors and non-survivors.
  • %FO > 20% was positively correlated with in-hospital mortality (OR = 2.878, P = 0.029).
  • Vasoactive drug use, multiple organ dysfunction syndrome, longer MV duration, and non-operative PICU admission were associated with increased mortality.

Conclusions:

  • Early FO and %FO > 10% were not independently associated with in-hospital mortality in this cohort.
  • %FO > 20% emerged as an independent risk factor for in-hospital mortality in critically ill children on MV.
  • The impact of early FO on mortality may be influenced by disease severity and interventions.
Abstract

Keywords:
ChildrenFluid overloadMechanical ventilationMortality

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