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Early Fluid Overload Prolongs Mechanical Ventilation in Children With Viral-Lower Respiratory Tract Disease*

Ingelse, Sarah A. MD; Wiegers, Hanke M. G. MSc; Calis, Job C. MD, PhD; van Woensel, Job B. MD, PhD; Bem, Reinout A. MD, PhD

Pediatric Critical Care Medicine: March 2017 - Volume 18 - Issue 3 - p e106–e111
doi: 10.1097/PCC.0000000000001060
Online Clinical Investigations

Objectives: Viral-lower respiratory tract disease is common in young children worldwide and is associated with high morbidity. Acute respiratory failure due to viral-lower respiratory tract disease necessitates PICU admission for mechanical ventilation. In critically ill patients in PICU settings, early fluid overload is common and associated with adverse outcomes such as prolonged mechanical ventilation and increased mortality. It is unclear, however, if this also applies to young children with viral-lower respiratory tract disease induced acute respiratory failure. In this study, we aimed to investigate the relation of early fluid overload with adverse outcomes in mechanically ventilated children with viral-lower respiratory tract disease in a retrospective dataset.

Design: Retrospective cohort study.

Setting: Single, tertiary referral PICU.

Patients: One hundred thirty-five children (< 2 yr old) with viral-lower respiratory tract disease requiring mechanical ventilation admitted to the PICU of the Academic Medical Center, Amsterdam between 2008 and 2014.

Interventions: None.

Measurements and Main Results: The cumulative fluid balance on day 3 of mechanical ventilation was compared against duration of mechanical ventilation (primary outcome) and daily mean oxygen saturation index (secondary outcome), using uni- and multivariable linear regression. In 132 children, the mean cumulative fluid balance on day 3 was + 97.9 (49.2) mL/kg. Higher cumulative fluid balance on day 3 was associated with a longer duration of mechanical ventilation in multivariable linear regression (β = 0.166; p = 0.048). No association was found between the fluid status and oxygen saturation index during the period of mechanical ventilation.

Conclusions: Early fluid overload is an independent predictor of prolonged mechanical ventilation in young children with viral-lower respiratory tract disease. This study suggests that avoiding early fluid overload is a potential target to reduce duration of mechanical ventilation in these children. Prospective testing in a clinical trial is warranted to support this hypothesis.

All authors: Department of Pediatric Intensive Care, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands.

*See also p. 289.

This study was performed at Pediatric Intensive Care Unit, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands.

This research was supported by the Ammodo Foundation and the Foundation of Pediatric Intensive Care (SKIC) in the Netherlands. The sponsor had no role in the design and execution of the research, the writing of the report or the decision to submit the article for publication. The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: s.a.ingelse@amc.uva.nl

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies