Fluid Overload and Outcomes in Pediatric Patients With Moderate or Severe Traumatic Brain Injury: Single-Center,...

To identify factors associated with fluid overload (FO) and early outcomes in pediatric patients with moderate or severe traumatic brain injury (TBI).

Retrospective cohort study using patient electronic medical records.

Hospital Universitario Fundación Valle del Lili, a tertiary care university hospital in Cali, Colombia.

Pediatric patients 1-16 years old treated in the PICU for moderate or severe TBI between 2011 and 2022.

We identified 158 pediatric patients who met study inclusion criteria. We recorded baseline clinical characteristics and interventions administered in the PICU. FO was defined as a cumulative fluid balance greater than or equal to 10% of body weight on the third day after trauma. Outcomes included mechanical ventilation (MV) duration, acute kidney injury (AKI), functional status, and mortality. Hypothesis tests and multivariable models assessed associations. FO occurred in 32 of 158 (20.2%) of patients at 72 hours and its presence was associated with lower weight ( p < 0.001) and age ( p < 0.001). On comparing those with and without FO, we failed to identify an association with mortality or AKI, respectively: 2 of 32 vs. 11 of 126 (mean difference 2.5% [95% CI, -11.9 to 10.2%], p = 0.65); 1 of 32 vs. 8 of 126 (mean difference 3.2% [95% CI, -9.8 to 9.4%], p = 0.49). However, FO compared with not, was associated with adjusted relative increases in MV duration (1.49 [95% CI, 1.08-2.04], p = 0.040) and PICU length of stay (1.44 [95% CI, 1.04-2.00], p < 0.001).

In our retrospective cohort from 2011 to 2022, FO occurred in approximately one in five pediatric TBI patients with moderate or severe injury. We also found that FO was associated with an adjusted relative increase in MV duration, but we failed to identify an association with other outcomes.