Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis

Furosemide is commonly prescribed in critically ill patients to increase the urine output and prevent fluid overload (FO) and acute kidney injury (AKI), but not supported by conclusive evidence. There remain conflicting findings on whether furosemide associates with AKI and adverse outcomes. Information on the impact of furosemide on adverse outcomes in a general population of pediatric intensive care unit (PICU) is limited. The aim of the cohort study was to investigate the associations of furosemide with AKI and clinical outcomes in critically ill children.Study Design: We retrospectively reviewed a cohort of 456 critically ill children consecutively admitted to PICU from January to December 2016. The exposure of interest was the use of furosemide in the first week after admission. FO was defined as ≥5% of daily fluid accumulation, and mean FO was considered significant when mean daily fluid accumulation during the first week was ≥5%. The primary outcomes were AKI in the first week after admission and mortality during PICU stay. AKI diagnosis was based on Kidney Disease: Improving Global Outcomes criteria with both serum creatinine and urine output.Results: Furosemide exposure occurred in 43.4% of all patients (n = 456) and 49.3% of those who developed FO (n = 150) in the first week after admission. Patients who were exposed to furosemide had significantly less degree of mean daily fluid accumulation than those who were not (1.10 [−0.33 to 2.61%] vs. 2.00 [0.54–3.70%], P < 0.001). There was no difference in the occurrence of AKI between patients who did and did not receive furosemide (22 of 198 [11.1%] vs. 36 of 258 [14.0%], P = 0.397). The mortality rate was 15.4% (70 of 456), and death occurred more frequently among patients who received furosemide than among those who did not (21.7 vs. 10.5%, P = 0.002). Furosemide exposure was associated with increased odds for mortality in a multivariate logistic regression model adjusted for body weight, gender, illness severity assessed by PRISM III score, the presence of mean FO, and AKI stage [adjusted odds ratio (AOR) 1.95; 95%CI, 1.08–3.52; P = 0.026].Conclusion: Exposure to furosemide might be associated with increased risk for mortality, but not AKI, in critically ill children.

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

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001841 ◽

2019 ◽

Vol 20 (3) ◽

pp. e130-e136 ◽

Cited By ~ 6

Author(s):

Jose C. Flores-González ◽

Cristina Montero Valladares ◽

Cristina Yun Castilla ◽

Juan Mayordomo-Colunga ◽

Sonia Pérez Quesada ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Fluid Overload ◽

Critically Ill Children

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Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

10.21203/rs.3.rs-923773/v1 ◽

2021 ◽

Author(s):

Zi-Hong Xiong ◽

Xue-Mei Zheng ◽

Guo-Ying Zhang ◽

Meng-Jun Wu ◽

Yi Qu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nutritional Status ◽

Clinical Outcomes ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Phase Angle ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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Clinical Outcomes Associated With RBC Transfusions in Critically Ill Children

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000000423 ◽

2015 ◽

Vol 16 (6) ◽

pp. 505-514 ◽

Cited By ~ 18

Author(s):

Pierre Demaret ◽

Marisa Tucci ◽

Oliver Karam ◽

Helen Trottier ◽

Thierry Ducruet ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Children

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Impact of Severe Sepsis on Serum and Urinary Biomarkers of Acute Kidney Injury in Critically Ill Children: An Observational Study

Blood Purification ◽

10.1159/000346629 ◽

2013 ◽

Vol 35 (1-3) ◽

pp. 172-176 ◽

Cited By ~ 29

Author(s):

Matteo Di Nardo ◽

Alessio Ficarella ◽

Zaccaria Ricci ◽

Rosa Luciano ◽

Francesca Stoppa ◽

...

Keyword(s):

Acute Kidney Injury ◽

Severe Sepsis ◽

Observational Study ◽

Critically Ill ◽

Kidney Injury ◽

Urinary Biomarkers ◽

Critically Ill Children

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Early Enteral Nutrition Is Associated With Improved Clinical Outcomes in Critically Ill Children

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002135 ◽

2020 ◽

Vol 21 (3) ◽

pp. 213-221 ◽

Cited By ~ 3

Author(s):

Vijay Srinivasan ◽

Natalie R. Hasbani ◽

Nilesh M. Mehta ◽

Sharon Y. Irving ◽

Sarah B. Kandil ◽

...

Keyword(s):

Enteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Children ◽

Early Enteral Nutrition

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A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors

BMC Pediatrics ◽

10.1186/s12887-020-02310-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yang Xue ◽

Chun-Feng Yang ◽

Yu Ao ◽

Ji Qi ◽

Fei-Yong Jia

Keyword(s):

Risk Factors ◽

Observational Study ◽

Clinical Outcomes ◽

Critically Ill ◽

Prospective Observational Study ◽

Critically Ill Children ◽

Diaphragmatic Dysfunction

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Impact of balanced versus unbalanced fluid resuscitation on clinical outcomes in critically ill children: protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-019-1109-2 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Anab Rebecca Lehr ◽

Soha Rached-d’Astous ◽

Melissa Parker ◽

Lauralyn McIntyre ◽

Margaret Sampson ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Critically Ill ◽

Fluid Resuscitation ◽

Meta Analysis ◽

Critically Ill Children

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Clinical Outcomes in Critically Ill Children With Excess Weight: A Retrospective Cohort Study

Nutrition in Clinical Practice ◽

10.1002/ncp.10541 ◽

2020 ◽

Author(s):

Caroline Abud Drumond Costa ◽

Rita Mattiello ◽

Gabriele Carra Forte ◽

Gabriela Rupp Hanzen Andrades ◽

Francielly Crestani ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Critically Ill ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Excess Weight ◽

Critically Ill Children

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Severe sepsis criteria, PELOD-2, and pSOFA as predictors of mortality in critically ill children with sepsis

Paediatrica Indonesiana ◽

10.14238/pi59.6.2019.318-24 ◽

2019 ◽

Vol 59 (6) ◽

pp. 318-24

Author(s):

Anindita Wulandari ◽

Pudjiastuti Pudjiastuti ◽

Sri Martuti

Keyword(s):

Severe Sepsis ◽

Inflammatory Response ◽

Critically Ill ◽

Organ Dysfunction ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Logistic Organ Dysfunction ◽

High Care ◽

Life Threatening ◽

Physical Examinations

Background Sepsis is one of the main causes of death in infants and children. Currently, it is defined as a life-threatening organ dysfunction, caused by an inflammatory response of infection. Several organ dysfunction assessment methods are available, but they are not uniformly used. Objective To compare the accuracy of three mortality predictor tools: severe sepsis criteria, pediatric logistic organ dysfunction (PELOD)-2, and pediatric sequential organ failure assessment (pSOFA), in critically ill children with sepsis. Methods This prospective cohort study was conducted in the pediatric intensive care unit (PICU) and pediatric high care unit (HCU) of dr. Moewardi Hospital, Surakarta, Central of Java. All patients who met the systemic inflammatory response syndrome (SIRS) criteria were included in our study. The exclusion criteria were congenital anomalies of heart or kidney, malignancy, or hematological abnormalities. The data were taken from laboratory and physical examinations by the physicians on duty. The outcome assessed was mortality. Results Of 30 subjects, the mean age was 22.22 (SD 29.36) months; the most common infection source was the respiratory tract, followed by gastrointestinal tract and central nervous system. Most subjects were treated in the PICU and had a mean length of stay of 8.70 (SD 11.91) days. Severe sepsis and PELOD-2 were not significant predictors of death. However, pSOFA score was a statistically significant predictor of mortality, with odds ratio 10.11 (95%CI 1.054 to 97.002; P=0.039). Conclusion Pediatric SOFA (pSOFA) is a better predictor of mortality compared to PELOD-2 and SIRS-severe sepsis. A pSOFA score ≥ 2 increases the risk of mortality by 10.11-fold.

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