Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury.
TLDR
Positive fluid balance was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect.Abstract:
Introduction. We analyzed a database of 320 pediatric patients with acute lung injury (ALI), to test the hypothesis that positive fluid balance is associated with worse clinical outcomes in children with ALI. Methods. This is a post-hoc analysis of previously collected data. Cumulative fluid balance was analyzed in ml per kilogram per day for the first 72 hours after ALI while in the PICU. The primary outcome was mortality; the secondary outcome was ventilator-free days. Results. Positive fluid balance (in increments of 10 mL/kg/24 h) was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect. These relationships remained unchanged when the subgroup of patients with septic shock (n = 39) were excluded. Conclusions. Persistently positive fluid balance may be deleterious to pediatric patients with ALI. A confirmatory, prospective randomized controlled trial of fluid management in pediatric patients with ALI is warranted.read more
Citations
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Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis.
Jonathan A Silversides,Jonathan A Silversides,Emmet Major,Andrew Ferguson,Emma E. Mann,Daniel F. McAuley,Daniel F. McAuley,John C. Marshall,John C. Marshall,Bronagh Blackwood,Eddy Fan +10 more
TL;DR: In adults and children with ARDS, sepsis or SIRS, a conservative or deresuscitative fluid strategy results in an increased number of ventilator-free days and a decreased length of ICU stay compared with a liberal strategy or standard care.
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Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis.
Rashid Alobaidi,Catherine Morgan,Rajit K. Basu,Erin K. Stenson,Robin Featherstone,Sumit R. Majumdar,Sean M. Bagshaw +6 more
TL;DR: Fuid overload is common and is associated with substantial morbidity and mortality in critically ill children and additional research should now ideally focus on interventions aimed to mitigate the potential for harm associated with fluid overload.
Journal ArticleDOI
Fluid balance in critically ill children with acute lung injury.
Stacey L. Valentine,Anil Sapru,Renee A. Higgerson,Phillip C. Spinella,Heidi R. Flori,Dionne A. Graham,Molly Brett,Maureen Convery,LeeAnn M. Christie,Laurie Karamessinis,Adrienne G. Randolph +10 more
TL;DR: The findings and the similarity of fluid balance patterns in the cohort to adults in the Fluid and Catheter Treatment Trial liberal arm demonstrate the need to determine whether a conservative fluid management strategy improves clinical outcomes in children with acute lung injury and support a Bayesian trial mirroring the Fl fluid balance trial.
Journal ArticleDOI
Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents.
TL;DR: How the capacity of the immune system to respond to infection develops over early life is reviewed and primary immune deficiencies that should be considered in children recurrently infected with specific types of organisms are brought attention.
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Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study
TL;DR: Investigation of the association of early fluid overload with respiratory morbidity and mortality in patients admitted to a general PICU population found there was no association of fluid overload at 48 hours with mortality.
References
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Journal ArticleDOI
The American-European Consensus Conference on ARDS: Definitions, mechanisms, relevant outcomes, and clinical trial coordination
Gordon R. Bernard,Antonio Artigas,Kenneth L. Brigham,J. Carlet,K. Falke,L. Hudson,M. Lamy,J. R. LeGall,Alan H. Morris,Roger G. Spragg +9 more
TL;DR: The acute respiratory distress syndrome (ARDS), a process of nonhydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies, carries a high morbidity, mortality, and financial cost.
Journal ArticleDOI
Comparison of two fluid-management strategies in acute lung injury.
Herbert P. Wiedemann,Arthur P. Wheeler,Gordon R. Bernard,B. Taylor Thompson,Douglas Hayden,Ben deBoisblanc,Alfred F Connors,R. Duncan Hite,Andrea L. Harabin +8 more
TL;DR: A conservative strategy of fluid management using explicit protocols applied for seven days in 1000 patients with acute lung injury improved the chances of death at 60 days and the conservative strategy improved fluid balance during the first seven days.
Journal ArticleDOI
PRISM III: An updated Pediatric Risk of Mortality score
TL;DR: A third-generation pediatric physiology-based score for mortality risk, Pediatric Risk of Mortality III (PRISM III), was developed and validated and resulted in several improvements over the original PRISM.
Journal ArticleDOI
Comparison of two fluid-management strategies in acute lung injury
TL;DR: Although there was no significant difference in the primary outcome of 60-day mortality, the conservative strategy of fluid management improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures.
Journal ArticleDOI
Improved Outcome Based on Fluid Management in Critically III Patients Requiring Pulmonary Artery Catheterization
TL;DR: A lower positive fluid balance, especially in patients with pulmonary edema regardless of cause, is associated with reduced EVLW, ventilator-days, and ICU days, as well as time on mechanical ventilation and time in the intensive care unit (ICU), in critically ill patients requiring pulmonary artery catheterization.
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