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Fluid Overload in Pediatric Univentricular Patients Undergoing Fontan Completion
Victorien A C Luppes1, Ariane Willems2, Mark G Hazekamp3
1Department of Pediatric Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Insights
Fluid overload (FO) in Fontan completion patients significantly increases pediatric intensive care unit (PICU) length of stay and the risk of cardiac events. Managing FO is crucial for better outcomes in these vulnerable children.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Fluid Balance Management
Background:
- Fluid overload (FO) is a common complication post-pediatric cardiac surgery, linked to increased morbidity and mortality.
- Fontan patients face a high risk of FO due to delicate fluid balance requirements and the need for adequate preload.
- Understanding FO's impact is critical for optimizing care in this high-risk population.
Purpose of the Study:
- To identify the presence of fluid overload (FO) in children undergoing Fontan completion.
- To evaluate the impact of FO on pediatric intensive care unit (PICU) length of stay (LOS).
- To assess the association between FO and cardiac events, including mortality, re-surgery, and re-hospitalization.
Main Methods:
- Retrospective, single-center study design.
- Inclusion of 43 consecutive pediatric patients undergoing Fontan completion.
- Assessment of fluid overload (FO) presence and quantification.
Main Results:
- Patients with >5% maximum FO experienced significantly longer PICU LOS (3.9 vs. 1.9 days) and mechanical ventilation duration (21 vs. 6 hours).
- A 1% increase in maximum FO correlated with a 13% increase in PICU LOS.
- Fluid overload (FO) was associated with a higher risk of adverse cardiac events.
Conclusions:
- Fluid overload (FO) is linked to both short-term (PICU LOS, ventilation) and long-term (cardiac events) complications in Fontan completion patients.
- Further research is necessary to fully elucidate the impact of FO on outcomes in this specific pediatric population.
- Early identification and management of FO may be crucial for improving patient outcomes.
Background:
Fluid overload (FO) is known to occur frequently after pediatric cardiac surgery and is associated with morbidity and mortality. Fontan patients are at risk to develop FO due to their critical fluid balance. Furthermore, they need an adequate preload in order to maintain adequate cardiac output. This study aimed to identify FO in patients undergoing Fontan completion and the impact of FO on pediatric intensive care unit (PICU) length of stay (LOS) and cardiac events, defined as death, cardiac re-surgery or PICU re-hospitalization during follow-up.
Methods:
In this retrospective single center study, the presence of FO was assessed in 43 consecutive children undergoing Fontan completion.
Results:
Patients with more than 5% maximum FO had an extended PICU LOS (3.9 [2.9-6.9] vs. 1.9 [1.0-2.6] days; p < 0.001) and an increased length of mechanical ventilation (21 [9-121] vs. 6 [5-10] h; p = 0.001). Regression analysis demonstrated that an increase of 1% maximum FO was associated with a prolonged PICU LOS of 13% (95% CI 1.042-1.227; p = 0.004). Furthermore, patients with FO were at higher risk to develop cardiac events.
Conclusions:
FO is associated with short-term and long-term complications. Further studies are needed to determine the impact of FO on the outcome in this specific population.
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