Clinical Outcomes Associated with Fluid Overload in Critically Ill Pediatric Patients

2019 ◽  
Vol 66 (2) ◽  
pp. 152-162 ◽  
Author(s):  
Ahmed El-Nawawy ◽  
Azza A Moustafa ◽  
Manal A M Antonios ◽  
May M Atta
Keyword(s):  
Critically Ill ◽  
Independent Risk Factor ◽  
Logistic Regression Model ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Fluid Overload ◽  
Fatal Outcome ◽  
Critical Threshold ◽  
Kaplan Meier ◽  
Pediatric Icu

Abstract Background Fluid overload (FO) has been accused as being one of the ICU problems affecting morbidity and mortality. The aim of the study was to assess the effect and critical threshold of FO that is related to mortality. Methods This prospective observational study was conducted in a pediatric ICU. All patients admitted (n = 203) during 12 months with a length of stay more than 48 h were recruited. Results FO was found to be related to mortality (p = 0.025) but was not proved to be an independent risk factor of fatal outcome by the logistic regression model. This raises the suspicion about any cause—effect relationship between FO and mortality. Even though, FO was statistically a fair discriminator of death (AUC = 0.655, p = 0.0008) and a cutoff level of FO was set at 7%. Kaplan–Meier curve showed that cumulative of survival differed significantly between groups of patients with FO more and less than 7% (p = 0.002) Conclusion Frequent and accurate monitoring of FO is crucial among critically ill patients. The present study suggested a threshold of 7% FO beyond which a more conservative regimen of fluid administration might improve patients’ outcome.

scholarly journals Novel use of an ultrafiltration device as an alternative method for fluid removal in critically ill pediatric patients with cardiac disease: a case series

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Sujata Chakravarti ◽  
Yasir Al-Qaqaa ◽  
Meghan Faulkner ◽  
Puneet Bhatla ◽  
Michael Argilla ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Fluid Overload ◽  
Case Series ◽  
Abdominal Distension ◽  
Common Complication ◽  
Flow Rates ◽  
Fluid Removal ◽  
Baxter Healthcare

Fluid overload (FO) is a common complication for pediatric patients in the intensive care unit. When conventional therapy fails, hemodialysis or peritoneal dialysis is classically used for fluid removal. Unfortunately, these therapies are often associated with cardiovascular or respiratory instability. Ultrafiltration, using devices such as the AquadexTM system (Baxter Healthcare, Deerfield, IL, USA), is an effective tool for fluid removal in adult patients with congestive heart failure. As compared to hemodialysis, ultrafiltration can be performed using smaller catheters, and the extracorporeal volume and minimal blood flow rates are lower. In addition, there is no associated abdominal distension as is seen in peritoneal dialysis. Consequently, ultrafiltration may be better tolerated in critically ill pediatric patients. We present three cases of challenging pediatric patients with FO in the setting of congenital heart disease in whom ultrafiltration using the AquadexTM system was successfully utilized for fluid removal while cardiorespiratory stability was maintained.

scholarly journals Fluid overload is an independent risk factor for acute kidney injury in critically Ill patients: results of a cohort study

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Nawal Salahuddin ◽  
Mustafa Sammani ◽  
Ammar Hamdan ◽  
Mini Joseph ◽  
Yasir Al-Nemary ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Risk Factor ◽  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Risk Factor ◽  
Fluid Overload ◽  
Kidney Injury

scholarly journals Adverse Outcomes due to Aggressive Fluid Resuscitation in Children: A Prospective Observational Study

2018 ◽  
Vol 08 (02) ◽  
pp. 064-070 ◽  
Author(s):  
Anand Muttath ◽  
Lalitha Annayappa Venkatesh ◽  
Joe Jose ◽  
Anil Vasudevan ◽  
Santu Ghosh
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Fluid Overload ◽  
Fluid Management ◽  
Oxygenation Index ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Mortality And Morbidity ◽  
The Impact

AbstractFluid management has a major impact on the duration, severity, and outcome of critically ill children. The aim of this study was to examine the relationship between cumulative fluid overload (CFO) with mortality and morbidity in critically ill children. This was a prospective observational study wherein children (1 month–16 years) who were critically ill (with shock requiring inotropes and/or mechanically ventilated) were enrolled. CFO was defined as the sum of daily fluid balances. Daily fluid balance was calculated as a difference between fluid intake (oral and intravenous) and output (urine output, discharge from nasogastric tube) in 24 hours. Percentage of fluid overload (FO) (PFO) was calculated as the ratio of CFO with weight at admission in kilogram. The CFO and PFO at 24, 48, 72 hours and at 7 days or end of PICU stay were calculated. A total of 291 children (244 survivors and 47 non-survivors; 47% males) were included in the final analysis. A higher mortality was observed in children with higher PFO (>20% FO: 45.8% mortality vs. 14.5% < 10% FO, p < 0.01) and CFO (10.97 ± 6.4 mL/kg in survivors vs. 13.95 ± 9.6 mL/kg in non-survivors; p = 0.022) at 72 hours. A 1% increase in fluid overload was associated with 6% and 4% increase in mortality at 72 hours and 7 days, respectively. Similarly, the impact of every 1% increase in fluid overload on both ventilation (yes/no) and acute kidney injury (AKI; yes/no) were found to be significant for both parameters at 72 hours, but only AKI had significant correlation on seventh day. In the multivariate stepwise Cox's proportional hazard model for PICU stay and hospital stay, 3% (p < 0.05) and 2% (p > 0.05) increase were found for every 1% increase in fluid overload, respectively. Oxygenation index is also associated with fluid overload with the adjusted model estimated 0.27 units (95% confidence interval: 0.18–0.36) increase per 1% increase in fluid overload. FO was associated with increased mortality and morbidity in critically ill children.

scholarly journals Fluid Overload as a Predictor of Lethal Outcome in Critically-Ill Children

2019 ◽  
Vol 15 (1) ◽  
pp. 12-26
Author(s):  
D. V. Prometnoi ◽  
Yu. S. Aleksandrovich ◽  
K. V. Pshenisnov
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Fluid Overload ◽  
Main Element ◽  
Critically Ill Children ◽  
Infusion Therapy ◽  
Fluid Loss ◽  
Lethal Outcome ◽  
Main Factors ◽  
Pediatric Icu

Infusion therapy is the main element of treatment of critical illness; at that, it is critical not only to eliminate hypovolemia, but also to prevent fluid overload. The purpose of the study was to identify predictors of a lethal outcome due to the peculiarities of infusion therapy and fluid balance in critically-ill children. Materials and methods. The study included 96 children admitted to the pediatric ICU. The average age of the children was 0.7 (0.2–2) years. Depending on the outcome, all patients were divided into two groups: I — «Recovery», II — «Lethal outcome». The daily volume of administered fluid, the volume of infusion therapy, the volume of pathological losses and fluid balance were estimated. Results. On the first day of therapy, parameters related to the volume of administered fluid were main factors that increased the probability of a lethal outcome; then mortality was associated with parameters related to the volume of discharged fluid. The volume of discharged fluid less than 20% of the administered volume increased the risk of a lethal outcome by 12-fold; the increase in the volume of fluid loss to 80% of the administered one contributed to a significant reduction in the risk of children's death. Conclusion. Positive fluid balance due to reduced volume of the discharged liquid is a major risk factor of a lethal outcome in children.

Association of Retinol-Binding Protein 4 with Arteriovenous Fistula Dysfunction in Hemodialysis Patients

2021 ◽  
pp. 1-8
Author(s):  
Yuanhao Wu ◽  
Fan Wang ◽  
Tingting Wang ◽  
Yin Zheng ◽  
Li You ◽  
...  
Keyword(s):  
Risk Factor ◽  
Arteriovenous Fistula ◽  
Independent Risk Factor ◽  
Binding Protein ◽  
Retinol Binding Protein ◽  
Youden Index ◽  
Serum Concentrations ◽  
Retinol Binding Protein 4 ◽  
Kaplan Meier ◽  
Increased Risk

<b><i>Background:</i></b> Arteriovenous fistula (AVF) is the most common vascular access for patients undergoing hemodialysis (HD). Neointimal hyperplasia (NIH) might be a potential mechanism of AVF dysfunction. Retinol-binding protein 4 (RBP4) may play an important role in the pathogenesis of NIH. The aim of this study was to investigate whether AVF dysfunction is associated with serum concentrations of RBP4 in HD subjects. <b><i>Methods:</i></b> A cohort of 65 Chinese patients undergoing maintenance HD was recruited between November 2017 and June 2019. The serum concentrations of RBP4 of each patient were measured with the ELISA method. Multivariate logistic regression was used to analyze data on demographics, biochemical parameters, and serum RBP4 level to predict AVF dysfunction events. The cutoff for serum RBP4 level was derived from the highest score obtained on the Youden index. Survival data were analyzed with the Cox proportional hazards regression analysis and Kaplan-Meier method. <b><i>Results:</i></b> Higher serum RBP4 level was observed in patients with AVF dysfunction compared to those without AVF dysfunction events (174.3 vs. 168.4 mg/L, <i>p</i> = 0.001). The prevalence of AVF dysfunction events was greatly higher among the high RBP4 group (37.5 vs. 4.88%, <i>p</i> = 0.001). In univariate analysis, serum RBP4 level was statistically significantly associated with the risk of AVF dysfunction (OR = 1.015, 95% CI 1.002–1.030, <i>p</i> = 0.030). In multivariate analysis, each 1.0 mg/L increase in RBP4 level was associated with a 1.023-fold-increased risk of AVF dysfunction (95% CI for OR: 1.002–1.045; <i>p</i> = 0.032). The Kaplan-Meier survival analysis indicated that the incidence of AVF dysfunction events in the high RBP4 group was significantly higher than that in the low-RBP4 group (<i>p</i> = 0.0007). Multivariate Cox regressions demonstrated that RBP4 was an independent risk factor for AVF dysfunction events in HD patients (HR = 1.015, 95% CI 1.001–1.028, <i>p</i> = 0.033). <b><i>Conclusions:</i></b> HD patients with higher serum RBP4 concentrations had a relevant higher incidence of arteriovenous dysfunction events. Serum RBP4 level was an independent risk factor for AVF dysfunction events in HD patients.

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