Related Experiment Video
Updated: Aug 19, 2025
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
Fluid Accumulation in Mechanically Ventilated, Critically Ill Children: Retrospective Cohort Study of Prevalence and
Ben Gelbart1, Ary Serpa Neto2, David Stephens3
1Paediatric Intensive Care Unit, University of Melbourne, Department of Paediatrics, Department of Critical Care, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
Insights
Fluid accumulation (FA) in mechanically ventilated children is linked to longer hospital stays and increased mortality, but only when exceeding 20%. Up to 10% FA showed reduced mortality, indicating a safe threshold.
Area of Science:
- Pediatric Critical Care Medicine
- Fluid Management in Mechanical Ventilation
- Clinical Outcomes Research
Background:
- Fluid accumulation (FA) is a common complication in critically ill children requiring mechanical ventilation (MV).
- Understanding the prevalence, patterns, and clinical impact of FA is crucial for optimizing patient care.
- Previous studies have not fully elucidated the association between varying degrees of FA and outcomes in this vulnerable population.
Purpose of the Study:
- To determine the prevalence, patterns, and associated variables of fluid accumulation in pediatric patients on mechanical ventilation.
- To investigate the relationship between fluid accumulation and key clinical outcomes, including duration of MV, length of stay, and mortality.
- To identify potential thresholds of FA that may indicate increased risk or benefit.
Main Methods:
- A retrospective cohort study was conducted in a tertiary pediatric intensive care unit (PICU).
- Data were collected from 1,636 children requiring mechanical ventilation for at least 24 hours between July 2016 and July 2021.
- Fluid accumulation was quantified as a percentage of estimated admission weight, and its association with clinical outcomes was analyzed.
Main Results:
- The median maximum cumulative fluid accumulation by day 7 was 7.5% of admission weight.
- Higher FA was initially associated with longer mechanical ventilation duration, intensive care, and hospital length of stay, as well as increased mortality.
- However, these associations were primarily driven by extreme FA values (>20%); FA up to 10% was not associated with adverse outcomes and showed reduced mortality.
Conclusions:
- In mechanically ventilated children, significant fluid accumulation (>20%) is associated with adverse outcomes, including prolonged hospital stays and higher mortality.
- Fluid accumulation up to 10% of body weight appears to be a safe threshold, with no increased risk and even a potential survival benefit.
- These findings highlight the importance of monitoring fluid balance and suggest that moderate FA may not necessitate aggressive interventions.
Objectives:
To describe the prevalence, patterns, explanatory variables, and outcomes associated with fluid accumulation (FA) in mechanically ventilated children.
Design:
Retrospective cohort study.
Setting:
Tertiary PICU.
Patients:
Children mechanically ventilated for greater than or equal to 24 hours.
Interventions:
None.
Measurements And Main Results:
Between July 2016 and July 2021, 1,636 children met eligibility criteria. Median age was 5.5 months (interquartile range [IQR], 0.7-46.5 mo), and congenital heart disease was the most common diagnosis. Overall, by day 7 of admission, the median maximum cumulative FA, as a percentage of estimated admission weight, was 7.5% (IQR, 3.3-15.1) occurring at a median of 4 days after admission. Overall, higher FA was associated with greater duration of mechanical ventilation (MV) (mean difference, 1.17 [95% CI, 1.13-1.22]; p < 0.001]), longer intensive care length of stay (LOS) (mean difference, 1.16 [95% CI, 1.12-1.21]; p < 0.001]), longer hospital LOS (mean difference, 1.19 [95% CI, 1.13-1.26]; p < 0.001]), and increased mortality (odds ratio, 1.31 [95% CI, 1.08-1.59]; p = 0.005). However, these associations depended on the effects of children with extreme values, and there was no increase in risk up to 20% FA, overall, in children following cardiopulmonary bypass and in children in the general ICU. When excluding children with maximum FA of >10%, there was no association with duration of MV (mean difference, 0.99 [95% CI, 0.94-1.04]; p = 0.64) and intensive care or hospital LOS (mean difference, 1.01 [95% CI, 0.96-1.06]; p = 0.70 and 1.01 [95% CI, 0.95-1.08]; 0.79, respectively) but an association with reduced mortality 0.71 (95% CI, 0.53-0.97; p = 0.03).
Conclusions:
In mechanically ventilated critically ill children, greater maximum FA was associated with longer duration of MV, intensive care LOS, hospital LOS, and mortality. However, these findings were driven by extreme values of FA of greater than 20%, and up to 10%, there was reduced mortality and no signal of harm.
More Related Videos
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
07:16An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Acute Respiratory Failure-III
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...