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Association of Fluid Overload With Clinical Outcomes in Critically Ill Children With Bronchiolitis

Bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) Study*

Flores-González, Jose C., PhD1; Valladares, Cristina Montero, PhD2; Yun Castilla, Cristina, MD3; Mayordomo-Colunga, Juan, PhD4; Quesada, Sonia Pérez, MD5; Martín Delgado, Carmen María, MD6; Goñi-Orayen, Concha, MD7; Fernández Carrión, Francisco, MD8; Veiga, Alicia Miras, MD9; Olmedilla-Jodar, Marta, MD10; Alcaraz Romero, Andrés J., PhD11; Eizmendi-Bereciartua, Miren, MD12; Gutierrez, Carmen Santiago, MD13; Luján, Esther Aleo, MD14; Navarro-Mingorance, Álvaro, MD15; Jordán, Iolanda, PhD16 for the Bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) WorkGroup

Pediatric Critical Care Medicine: March 2019 - Volume 20 - Issue 3 - p e130–e136
doi: 10.1097/PCC.0000000000001841
Online Clinical Investigations

Objectives: Increasing evidence supports the association of fluid overload with adverse outcomes in different diseases. To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis.

Design: Descriptive, prospective, multicenter study.

Setting: Sixteen Spanish PICUs.

Patients: Severe acute bronchiolitis who required admission from October 2014 to May 2015 were included.

Interventions: None.

Measurements and Main Results: Total fluid intake and output were prospectively recorded during PICU assistance. Fluid balance was measured at 24, 48, and 72 hours after PICU admission. A total of 262 patients were enrolled; 54.6% were male. Median age was 1 month (interquartile range, 1–3 mo). Patients had a positive fluid balance during the first 4 days of PICU admission, reaching a neutral balance on day 4. A positive balance at 24 hours in patients admitted to the PICU with severe bronchiolitis was related with longer stay in PICU (p < 0.001), longer hospital stay (p < 0.001), longer duration of mechanical ventilation (p = 0.016), and longer duration of noninvasive ventilation (p = 0.0029).

Conclusions: Critically ill patients with severe acute bronchiolitis who present a positive balance in the first 24 hours of PICU admission have poorer clinical outcomes with longer PICU and hospital length of stay and duration of invasive and noninvasive mechanical ventilation.

1Paediatric Intensive Care Unit, University Hospital Puerta del Mar, Institut INIBICA, Cádiz, Spain.

2Paediatric Intensive Care Unit, University Hospital Virgen Del Rocío, Sevilla, Spain.

3Paediatric Intensive Care Unit, University Regional Hospital of Málaga, Spain.

4Paediatric Intensive Care Unit, University Hospital Central of Asturias, Oviedo, Spain.

5Paediatric Intensive Care Unit, General University Hospital of Alicante, Spain.

6Paediatric Intensive Care Unit, Hospital Virgen de la Salud, Toledo, Spain.

7Paediatric Intensive Care Unit, Hospital Complex of Pamplona, Spain.

8Paediatric Intensive Care Unit, University Hospital of Salamanca, Spain.

9Paediatric Intensive Care Unit, Hospital de Burgos, Spain.

10Paediatric Intensive Care Unit, Hospital 12 de Octubre, Madrid, Spain.

11Paediatric Intensive Care Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain.

12Paediatric Intensive Care Unit, Hospital Universitario Donostia, San Sebastián, Spain.

13Paediatric Intensive Care Unit, Hospital de Jaén, Jaén, Spain.

14Paediatric Intensive Care Unit, Hospital Clínico San Carlos, Spain.

15Paediatric Intensive Care Unit, Hospital Virgen de la Arrixaca, Murcia, Spain.

16Paediatric Intensive Care Unit, Hospital Sant Joan de Deu, Institut Recerca, CIBERES, Barcelona, Spain.

*See also p. 301.

The authors have disclosed that they do not have any potential conflicts of interest.

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©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies