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Fluid balance in critically ill children with lower respiratory tract viral infection: a cohort study
Chiara Robino1, Guido Toncelli1, Laura Arianna Sorrentino2
1Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy.
Insights
In critically ill children with viral respiratory infections, daily fluid balance did not correlate with the duration of respiratory support. This finding suggests fluid overload may not impact pulmonary function outcomes in this pediatric patient group.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Respiratory Medicine
- Fluid Balance Management
Background:
- Positive fluid balance is linked to adverse outcomes in critically ill patients.
- Understanding fluid balance patterns in pediatric lower respiratory tract infections is crucial.
Purpose of the Study:
- To investigate daily fluid balance patterns in critically ill children with viral lower respiratory tract infections.
- To determine the association between fluid balance and respiratory support duration or pulmonary function.
Main Methods:
- Retrospective single-center study of pediatric patients on respiratory support (HFNC, NIV, or invasive ventilation).
- Analysis of daily fluid balances, cumulative fluid overload (FO), and peak FO over the first week of Pediatric Intensive Care Unit (PICU) admission.
- Indexed fluid balance metrics as a percentage of admission body weight.
Main Results:
- A total of 94 children were analyzed, with a median age of 6.9 months.
- Daily fluid balance showed variations over the first week, with a trend towards increase by day 7 (p=0.001).
- No significant correlation was found between fluid balance parameters and respiratory support duration or oxygen saturation.
Conclusions:
- In children with viral bronchiolitis, fluid balance was not associated with respiratory support duration.
- Fluid overload did not correlate with pulmonary function parameters in this pediatric cohort.
Background:
Increasing evidence has associated positive fluid balance of critically ill patients with poor outcomes. The aim of this study was to explore the pattern of daily fluid balances and their association with outcomes in critically ill children with lower respiratory tract viral infection.
Methods:
A retrospective single-center study was conducted, in children supported with high-flow nasal cannula, non-invasive ventilation, or invasive ventilation. Median (interquartile range) daily fluid balances, cumulative fluid overload (FO) and peak FO variation, indexed as the % of admission body weight, over the first week of Pediatric Intensive Care Unit admission, and their association with the duration of respiratory support were assessed.
Results:
Overall, 94 patients with a median age of 6.9 (1.9-18) months, and a respiratory support duration of 4 (2-7) days, showed a median (interquartile range) daily fluid balance of 18 (4.5-19.5) ml/kg at day 1, which decreased up to day 3 to 5.9 (- 14 to 24.9) ml/kg and increased to 13 (- 11 to 29.9) ml/kg at day 7 (p = 0.001). Median cumulative FO% was 4.6 (- 0.8 to 11) and peak FO% was 5.7 (1.9-12.4). Daily fluid balances, once patients were stratified according to the respiratory support, were significantly lower in those requiring mechanical ventilation (p = 0.003). No correlation was found between all examined fluid balances and respiratory support duration or oxygen saturation, even after subgroup analysis of patients with invasive mechanical ventilation, or respiratory comorbidities, or bacterial coinfection, or of patients under 1 year old.
Conclusions:
In a cohort of children with bronchiolitis, fluid balance was not associated with duration of respiratory support or other parameters of pulmonary function.
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