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Analysis of Fluid Balance as Predictor of Length of Assisted Mechanical Ventilation in Children Admitted to Pediatric
1Department of Pediatrics, Adichunchanagiri Institute of Medical Sciences, Mandya 571448, India.
Insights
Prolonged mechanical ventilation is linked to positive fluid balance and high PIM2 scores. Managing fluid balance can reduce ventilation duration and PICU stays.
Area of Science:
- Critical Care Medicine
- Pediatric Intensive Care
- Respiratory Physiology
Background:
- Ventilator-associated lung injury (VALI) is a severe complication of assisted mechanical ventilation (AMV).
- VALI is a primary cause of prolonged AMV, necessitating strategies to mitigate its effects.
- Understanding factors contributing to prolonged AMV is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the association between fluid balance and prolonged AMV.
- To determine the relationship between the Pediatric Index of Mortality 2 (PIM2) score and prolonged AMV.
- To identify key indicators for predicting the need for extended mechanical ventilation in pediatric patients.
Main Methods:
- Prospective observational study conducted over 12 months in a pediatric intensive care unit (PICU).
- Fluid balance calculated from input-output over the initial 48 hours of AMV.
- PIM2 score documented on admission; statistical analyses included chi-square and Mann-Whitney U tests.
Main Results:
- A positive fluid balance (≥15%) was associated with prolonged mechanical ventilation in 27 out of 40 patients.
- A PIM2 score (≥5) was also linked to prolonged AMV in 27 patients.
- Significant associations found between positive fluid balance (P=2.25×10⁻⁷) and PIM2 score (P=1.19×10⁻⁵) with prolonged AMV.
Conclusions:
- Positive fluid balance (>15%) and elevated PIM2 scores (>5) are significantly associated with prolonged AMV.
- Strict fluid balance management and timely interventions can potentially shorten AMV duration.
- Reducing AMV duration may lead to decreased PICU length of stay.
Background:
Ventilator-associated lung injury (VALI) is a devastating complication of assisted mechanical ventilation (AMV) and is one of the root causes of prolonged AMV. Many strategies were made to decrease the effect of the same. This study is conducted to determine the association of prolonged AMV with fluid balance and pediatric index of mortality 2 (PIM2) score.
Methods:
This prospective observational study was carried out in a PICU of a tertiary care centre over a period of 12 months. Patient's fluid balance was calculated by tabulating fluid input-output over initial 48 hours of AMV. The PIM2 score on admission was documented. The association between qualitative variables was assessed by a chi-square test. Comparison of quantitative data measured between cases with duration of AMV ≥ 7 days and <7 days was done using the Mann-Whitney U test. Correlation between quantitative data was done by using the Pearson product moment correlation.
Results:
Out of 40 patients, 27 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 27 patients with PIM2 score ≥ 5 required prolonged AMV. On applying the Pearson chi-square test, we found a significant association between positive fluid balance and prolonged mechanical ventilation (P value = 2.25 × 10-7 (<0.05)). Likewise, a statistically significant association was found between PIM2 score and prolonged ventilation (P value = 1.19 × 10-5 (<0.05)).
Conclusion:
There is a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.
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