Author Of 1 Presentation
EFFECTS OF FLUID OVERLOAD IN MECHANICALLY VENTILATED CHILDREN WITH PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME
Abstract
Background
Background: Studies in adult ARDS have shown an association between fluid overload (FO) and worse outcome. Data in pediatric acute respiratory distress syndrome (PARDS) is limited, although few studies have demonstrated worsening oxygenation and lesser ventilator free days.
Objectives
To study the effects of FO in children with PARDS
Methods
Prospective observational study between August 2017–August 2018, in a tertiary level PICU of a teaching hospital in India, including 48 children aged 31 days to 12 years, mechanically ventilated for PARDS (PALICC definition)
Results
The median(IQR) P/F ratio was 164(122,213), while oxygenation index(OI) was 7.21(4.7,13.9). Thirty five children (72.9%) had severe, 9(18.8%) had moderate and 4(8.3%) had mild PARDS. Thirty two(66.6%) children had FO% >10; more in severe than in mild-moderate ARDS (80% vs. 30.8%; P<0.001). The odds of severe ARDS increased by nearly 9 times in children with FO(OR 9; 95% CI 6.13-13.22; P<0.0001). On linear mixed modelling regression analysis, peak FO%(PFO) was a significant predictor of worst OI(F-value 23.47; P<0.001); for every 1% increase in PFO, worst OI increased by 0.67(95% CI 0.40-0.94;P<0.001).Similarly for every 1% increase in daily FO%(DFO), mean OI increased by 0.9[95% CI:0.82-0.96; P<0.001].Twenty five (83.3%) non-survivors as against 7(38.8%) survivors had FO(P= 0.002). FO was seen in 23(74.2%) out of 31 with progressive MODS, 22(73.2%) out of 30 with AKI, and 14(73.7%) out of 19 with myocardial dysfunction.
Conclusion
Fluid overload is a significant contributor to severity of ARDS; unit change in daily or peak FO% leads to significant increases in OI and mortality.