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Fluid Overload at 48 Hours Is Associated With Respiratory Morbidity but Not Mortality in a General PICU: Retrospective Cohort Study*

Sinitsky, Lynn MB, MRCPCH1; Walls, David BSc2; Nadel, Simon MB, FRCP1; Inwald, David P. FRCPCH, PhD2

Pediatric Critical Care Medicine: March 2015 - Volume 16 - Issue 3 - p 205–209
doi: 10.1097/PCC.0000000000000318
Feature Articles

Objective: Recent evidence suggests that fluid overload may be deleterious to critically ill children. The purpose of this study was to investigate the association of early fluid overload with respiratory morbidity and mortality in patients admitted to a general PICU.

Design: Retrospective cohort study.

Setting: Single, tertiary referral PICU.

Patients: Six hundred thirty-six patients aged 0–16 years invasively ventilated at 48 hours post admission, admitted between April 1, 2009, and March 31, 2013.

Measurements and Main Results: Data collected included demographics, diagnosis, Pediatric Index of Mortality 2 score, and fluid overload percent at 48 hours from admission. Fluid overload percent was calculated as (cumulative fluid in – cumulative fluid out (L))/hospital admission weight (kg) × 100%. Outcome measures were oxygenation index at 48 hours from admission, death, and invasive ventilation days in survivors. Data are reported as median (interquartile range) and were analyzed using nonparametric tests. The median age was 1.05 years (0.3–4.2 yr). Fifty-three patients (8%) died. Median duration of ventilation in survivors was 5 days (3–8 d). Fluid overload percent correlated significantly with oxygenation index (Spearman ρ, 0.318; p < 0.0001) and with invasive ventilation days in survivors (Spearman ρ, 0.274; p < 0.0001). There was no significant difference in fluid overload percent between survivors and nonsurvivors. Regression analysis demonstrated that fluid overload percent was a significant predictor of both oxygenation index at 48 hours (p < 0.001) and invasive ventilation days (p = 0.002).

Conclusions: Fluid overload at 48 hours was associated with oxygenation index at 48 hours and invasive ventilation days in survivors in a general PICU population. There was no association of fluid overload at 48 hours with mortality.

1Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, United Kingdom.

2Patient Care & Clinical Informatics, Healthcare, Philips, Guildford, United Kingdom.

* See also p. 289.

This study was performed at Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, United Kingdom.

Mr. Nadel received support from the National Institute for Health Research Biomedical Research Centre.

Dr. Inwald received support for article research from the Imperial College Biomedical Research Centre. Dr. Nadel consulted and lectured for Novartis Vaccines. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2015The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies