Association between early fluid overload and mortality in critically-ill mechanically ventilated children: a single-center retrospective cohort study

Abstract Background Positive fluid overload (FO) may cause adverse effect. This study retrospectively analyzed the relationship between early FO and in-hospital mortality in children with mechanical ventilation (MV) in pediatric intensive care unit (PICU). Methods This study retrospectively enrolled 309 children (ages 28 days to 16 years) receiving invasive MV admitted to the PICU of Xinhua Hospital from March 2014 to March 2019. Children receiving MV for less than 48 h were excluded. The FO in the first 3 days of MV was considered to the early FO. Patients were divided into groups according to early FO and survival to evaluate the associations of early FO, percentage FO(%FO) > 10%, and %FO > 20% with in-hospital mortality. Results A total of 309 patients were included. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). There were no significant differences in mortality among different FO groups (P = 0.053) or in early FO between survivors and non-survivors (P = 0.992). Regression analysis demonstrated that use of more vasoactive drugs, the presence of multiple organ dysfunction syndrome, longer duration of MV, and a non-operative reason for PICU admission were related to increased mortality (P < 0.05). Although early FO and %FO > 10% were not associated with in-hospital mortality (β = 0.030, P = 0.090, 95% CI = 0.995–1.067; β = 0.479, P = 0.153, 95% CI = 0.837–3.117), %FO > 20% was positively correlated with mortality (β = 1.057, OR = 2.878, P = 0.029, 95% CI = 1.116–7.418). Conclusions The correlation between early FO and mortality was affected by interventions and the severity of the disease, but %FO > 20% was an independent risk factor for in-hospital mortality in critically ill MV-treated children.

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Association between Early Fluid Overload and Mortality in Critically-ill Mechanically Ventilated Children: A Single Center Prospective Cohort Study

10.21203/rs.3.rs-518747/v1 ◽

2021 ◽

Author(s):

Xiangmei Kong ◽

Xiaodong Zhu ◽

Yueniu Zhu

Keyword(s):

Mechanical Ventilation ◽

Regression Analysis ◽

Hospital Mortality ◽

Critically Ill ◽

Fluid Overload ◽

Stepwise Logistic Regression ◽

Stepwise Logistic Regression Analysis ◽

Mechanically Ventilated ◽

Significant Difference ◽

Early Fluid

Abstract Background: This study retrospectively analyzed the relationship between early fluid overload(FO) and in-hospital mortality in Children with mechanical ventilation in pediatric intensive care unit.Methods: Patients who were on mechanical ventilation (MV) for≥48 h and aged over 28 days and less than 18 years from March 2014 to March 2019 in department of PICU, Xinhua hospital. Daily FO was calculated as {(daily fluid intake-daily fluid output)/weight at ICU admission * 100%}.We defined the early FO as the FO in the first three days of mechanical ventilation, and divided it into four bands: %FO ≤ 0%, 0%＜%FO≤ 10%, 10%＜%FO≤ 20%, and %FO > 20%. We compared the mortality in discharge between groups with different FO. We also compared the early FO between survivors and non-survivors. Multivariate stepwise logistic regression analysis was used to analyze the prognostic factors of mortality in hospital.Results: 309 patients were included. There were 202 cases in non-operative and 107 cases in operative. The mean early FO was 8.83 ± 8.81%, and the mortality in hospital was 26.2% (81/309). The percentage of % FO＞10% was in present 41.4%(131/309) and %FO＞20% was in present 8.7% (27/309). There was no significant difference in discharge-mortality between different FO groups(p=0.053) and in FO between survivors and non-survivors(p=0.992). Regression analysis demonstrated that the more vasoactive drugs, the presence of MODS, the longer duration of MV, and the non-operation reason for PICU admission were related to the increase of mortality(p＜0.05); although early FO and %FO>10% were not associated with in-hospital mortality(β=0.030, p=0.090, 95% C.I.=0.995~1.067; β=0.479, p=0.153, 95% C.I.= 0.837~3.117), %FO>20% was related to the increase of mortality (β=1.057, OR=2.878, p=0.029, 95% C.I.=1.116~7.418). There was positive correlation between early FO and LOS in PICU (r=0.148, p=0.009), but the relation is weak.Conclusions: Affected by interventions and the severity of the disease, the correlation between the early FO and %FO>10% with mortality was not clear, but %FO>20% was related to the increase of mortality in critically-ill mechanically ventilated Children. Trial registration: Not applicable

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The Association Between Variability in Electrolytes and the In-Hospital Mortality in Critically Ill Children in Pediatric Intensive Care Units

Frontiers in Pediatrics ◽

10.3389/fped.2021.692894 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jilei Lin ◽

Yin Zhang ◽

Meng Chen ◽

Jihong Dai ◽

Anchao Song ◽

...

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Units ◽

Critically Ill ◽

Pediatric Intensive Care ◽

High Variability ◽

Critically Ill Children ◽

Retrospective Case ◽

Potassium Sodium ◽

The Mean

Objective: This study aimed to explore the association between the variability in electrolytes and the in-hospital mortality in critically ill children admitted into intensive care units (ICUs).Design: This is a retrospective case–control study.Setting and Participants: Total of 11,245 children have been admitted to ICUs of Children's Hospital of Zhejiang University from 2010 to 2018.Methods: The coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM) were calculated as variability indices. High variability was defined as having values in the highest quartile for each parameter. Age, sex, diagnoses of disease, and surgical treatment were adjusted in the multivariable-adjusted logistic regression model.Results: A total of 11,245 children were included, and 660 patients died in the hospital. The median (P25, P75) potassium, sodium, and chloride of all patients were 3.8 (3.58, 4.09), 136.83 (135.11, 138.60), and 108.67 (105.71, 111.17), respectively. U-shaped relationships between the mean, lowest, and highest levels of potassium, sodium, and chloride and the in-hospital mortality were observed. The lowest mortality was noted when serum potassium, sodium, and chloride were between ~3.5 and 5.0, 135 and 145, and 105 and 115 mmol/l, respectively. The areas under the curve (AUCs) of three indices of variability in electrolytes were larger than those of the mean and lowest levels of electrolytes in predicting the in-hospital mortality. In the multivariable-adjusted model, the odds ratios and 95% confidence interval (CI) of the in-hospital mortality were 3.14 (2.44–4.04) for one parameter, 5.85 (4.54–7.53) for two parameters, and 10.32 (7.81–13.64) for three parameters compared with subjects having no parameters of high variability measured as the CV. The results were consistent when the variability was determined using the SD and VIM (all P for trend <0.001). Consistent results were noted in various subgroup analyses.Conclusions: This study showed that individuals with higher variability of each parameter were related with higher risk of in-hospital mortality. There was a linear association between the number of high variability parameters and the in-hospital mortality. The variability of electrolytes might be a good predictor for in-hospital mortality of children in ICUs.

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

Scientific Reports ◽

10.1038/s41598-021-87409-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoling Zhang ◽

Jingjing Zhang ◽

Jiamei Li ◽

Ya Gao ◽

Ruohan Li ◽

...

Keyword(s):

Blood Glucose ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Venous Blood ◽

Sensitivity Analyses ◽

Icu Mortality ◽

Logistic Regression Models ◽

The Mean ◽

The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

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A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy

Journal of Intensive Care Medicine ◽

10.1177/0885066617724339 ◽

2017 ◽

Vol 34 (11-12) ◽

pp. 985-989 ◽

Cited By ~ 3

Author(s):

Ayse Filiz Yetimakman ◽

Selman Kesici ◽

Murat Tanyildiz ◽

Umut Selda Bayrakci ◽

Benan Bayrakci

Keyword(s):

Critically Ill ◽

Metabolic Diseases ◽

Fluid Overload ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Standardized Mortality Ratio ◽

Inborn Errors ◽

Fluid Removal ◽

Continuous Renal Replacement Therapies ◽

Organ Failures

Background: Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. Materials and Method: A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors. Results: The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8. Conclusion: The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.

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Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽

10.1161/circ.142.suppl_3.15293 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Barry Burstein ◽

Vidhu Anand ◽

Bradley Ternus ◽

Meir Tabi ◽

Nandan S Anavekar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Power Output ◽

Critically Ill Patients ◽

Cardiac Intensive Care Unit ◽

Cardiac Power ◽

The Mean ◽

Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

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