Fluid Overload in Pediatric Acute Respiratory Distress Syndrome after Allogeneic Hematopoietic Cell Transplantation

Area of Science:

• Pediatric Critical Care Medicine
• Hematopoietic Cell Transplantation
• Respiratory Physiology

Background:

• Pediatric acute respiratory distress syndrome (PARDS) is a significant complication following hematopoietic cell transplantation (HCT).
• Fluid overload (FO) is common in critically ill children and may impact respiratory mechanics.
• The relationship between FO and respiratory dysfunction severity in post-HCT PARDS patients requires further elucidation.

Purpose of the Study:

• To investigate the association between daily fluid overload percentage (FO%) and respiratory dysfunction severity, measured by the oxygenation index (OI), in children with PARDS post-HCT.
• To determine if FO% independently correlates with oxygenation impairment in this vulnerable pediatric population.

Main Methods:

• Secondary analysis of a multicenter retrospective cohort of 158 children (1 month to 21 years) post-allogeneic HCT with PARDS requiring invasive mechanical ventilation (IMV).
• Daily FO% and OI were calculated for the first week of IMV.
• Linear mixed-effect regression models were used to assess the association between FO% and OI, adjusting for relevant factors.

Main Results:

• Increasing FO% was strongly associated with a higher OI (adjusted β = 4.6; 95% CI: [2.9, 6.3]), indicating worsening oxygenation.
• The association between FO% and OI was most significant in children with severe PARDS and within the first three days of IMV.
• FO% was also associated with lower PaO2/FiO2 ratios (adjusted β = -1.92; 95% CI: [-3.11, -0.73]) but not with mean airway pressure.

Conclusions:

• Fluid overload is an independent predictor of oxygenation impairment in children with PARDS following HCT.
• Aggressive fluid management strategies may be crucial in mitigating respiratory dysfunction, particularly in severe PARDS cases early in the course of IMV.
• Further prospective studies are warranted to confirm these findings and explore therapeutic interventions targeting fluid balance in post-HCT PARDS.