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The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: a Cohort Study
Nisha Agasthya1,2, Kimberlee Chromey1,2, James H Hertzog1,2
1Department of Pediatrics, Division of Critical Care Medicine, Nemours A.I. duPont Hospital for Children, Wilmington, DE, USA.
Insights
Diuretics like furosemide are commonly used in mechanically ventilated children with viral bronchiolitis and fluid overload. Restrictive fluid strategies may offer benefits, but further research is needed on diuretic effects.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Pharmacology
Background:
- Viral bronchiolitis is a primary cause of pediatric intensive care unit (PICU) admissions.
- Limited data exist on fluid overload and diuretic use in mechanically ventilated children with viral bronchiolitis.
Purpose of the Study:
- To investigate diuretic use in relation to fluid overload among mechanically ventilated children diagnosed with viral bronchiolitis.
Main Methods:
- Retrospective cohort study at a quaternary children's hospital.
- Included mechanically ventilated children with confirmed viral bronchiolitis (PCR tested), excluding comorbidities.
- Compared outcomes between children who received and did not receive diuretics.
Main Results:
- Furosemide was administered to 79% of patients by Day 2 of ventilation, commonly via intermittent IV doses.
- Higher initial fluid overload correlated with longer mechanical ventilation duration and hospital stay, even with furosemide use.
- Superimposed bacterial pneumonia occurred in 60% of cases, associated with increased 24-hour fluid overload.
Conclusions:
- Diuretics are frequently employed for fluid overload in this patient group, with intermittent furosemide being prevalent.
- Potential benefits for oxygenation exist, but require further investigation for efficacy and safety.
- Restrictive fluid management strategies may be advantageous due to the risks associated with fluid overload.
Introduction:
Viral bronchiolitis is a leading cause of admissions to pediatric intensive care unit (PICU). A literature review indicates that there is limited information on fluid overload and the use of diuretics in mechanically ventilated children with viral bronchiolitis. This study was conducted to understand diuretic use concerning fluid overload in this population.
Material And Methods:
A retrospective cohort study performed at a quaternary children's hospital. The study population consisted of mechanically ventilated children with bronchiolitis, with a confirmed viral diagnosis on polymerase chain reaction (PCR) testing. Children with co-morbidities were excluded. Data collected included demographics, fluid status, diuretic use, morbidity and outcomes. The data were compared between groups that received or did not receive diuretics.
Result:
Of the 224 mechanically ventilated children with confirmed bronchiolitis, 179 (79%) received furosemide on Day 2 of invasive ventilation. Out of these, 72% of the patients received intermittent intravenous furosemide, whereas 28% received continuous infusion. It was used more commonly in patients who had a higher fluid overload. Initial fluid overload was associated with longer duration of mechanical ventilation (median days 6 vs 4, p<0.001) and length of stay (median days 10 vs 6, p<0.001) even with the use of furosemide. Superimposed bacterial pneumonia was seen in 60% of cases and was associated with a higher per cent fluid overload at 24 hours (9.1 vs 6.3, p = 0.003).
Conclusion:
Diuretics are frequently used in mechanically ventilated children with bronchiolitis and fluid overload, with intermittent dosing of furosemide being the commonest treatment. There is a potential benefit of improved oxygenation in these children, though further research is needed to quantify this benefit and any potential harm. Due to potential harm with fluid overload, restrictive fluid strategies may have a potential benefit.
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