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Treffer: Fluid overload is associated with impaired oxygenation and morbidity in critically ill children.

Title:
Fluid overload is associated with impaired oxygenation and morbidity in critically ill children.
Authors:
Arikan AA; Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. aysea@bcm.edu, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL
Source:
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2012 May; Vol. 13 (3), pp. 253-8.
Publication Type:
Evaluation Study; Journal Article
Language:
English
Journal Info:
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 100954653 Publication Model: Print Cited Medium: Internet ISSN: 1529-7535 (Print) Linking ISSN: 15297535 NLM ISO Abbreviation: Pediatr Crit Care Med Subsets: MEDLINE
Imprint Name(s):
Original Publication: Baltimore, MD : Lippincott Williams & Wilkins, c2000-
MeSH Terms:
Fluid Therapy/*adverse effects , Oxygen/*blood , Respiratory Insufficiency/*complications , Water-Electrolyte Imbalance/*etiology, Child ; Child, Preschool ; Critical Care/statistics & numerical data ; Critical Illness ; Female ; Humans ; Intensive Care Units, Pediatric ; Length of Stay/statistics & numerical data ; Linear Models ; Logistic Models ; Male ; Multivariate Analysis ; Oximetry ; Proportional Hazards Models ; Respiration, Artificial/statistics & numerical data ; Respiratory Insufficiency/blood ; Respiratory Insufficiency/mortality ; Respiratory Insufficiency/therapy ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; Water-Electrolyte Imbalance/blood ; Water-Electrolyte Imbalance/therapy
Comments:
Comment in: Pediatr Crit Care Med. 2012 May;13(3):348-9. doi: 10.1097/PCC.0b013e31822f159d. (PMID: 22561259)
Substance Nomenclature:
S88TT14065 (Oxygen)
Entry Date(s):
Date Created: 20110716 Date Completed: 20120831 Latest Revision: 20220819
Update Code:
20250114
DOI:
10.1097/PCC.0b013e31822882a3
PMID:
21760565
Database:
MEDLINE

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Rationale: Fluid overload is common in the critically ill and is thought to contribute to oxygenation failure and mortality. Since increasing disease severity often requires more fluid for resuscitation, it is unclear whether fluid overload is a causative factor in morbidity or is simply an indicator of disease severity.
Objective: Investigate the association between fluid overload and oxygenation while controlling for severity of illness by daily Pediatric Logistic Organ Dysfunction scores.
Design and Setting: Retrospective chart review, tertiary children's hospital.
Patients and Methods: The oxygenation index, fluid overload percent, and daily Pediatric Logistic Organ Dysfunction scores were obtained in a retrospective chart review of 80 patients (mean age 58.7 ± 73.0 months) with respiratory failure. Univariate and multivariate approaches were used to assess the independent relation between fluid overload percent and duration of stay and ventilation.
Interventions: None.
Main Results: Higher peak fluid overload percent predicted higher peak oxygenation index, independent of age, gender, and Pediatric Logistic Organ Dysfunction (p = .009). Fluid overload percent ≥15% on any given day was also independently associated with that day's oxygenation index, controlled for age, gender, and Pediatric Logistic Organ Dysfunction (p < .05). Peak fluid overload percent and severe fluid overload percent (≥15%) were both independently associated with longer duration of ventilation (p = .004, p = .01), and pediatric intensive care unit (p = .008, p = .01) and hospital length of stay (p = .02, p = .04), controlled for age, gender, Pediatric Logistic Organ Dysfunction, and in the case of ventilation, respiratory admission.
Conclusion: This is the first study to report that positive fluid balance adversely affected the pediatric intensive care unit course in children who did not receive renal replacement therapy. While timely administration of fluids is lifesaving, positive fluid balance after hemodynamic stabilization may impact organ function and negatively influence important outcomes in critically ill patients.