Flori Heidi R, Church Gwynne, Liu Kathleen D, Gildengorin Ginny, Matthay Michael A
Division of Pediatric Critical Care, Children's Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA.
Crit Care Res Pract. 2011;2011:854142. doi: 10.1155/2011/854142. Epub 2011 May 29.
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.
引言。我们分析了一个包含320例急性肺损伤（ALI）儿科患者的数据库，以检验正液体平衡与ALI患儿较差临床结局相关这一假设。方法。这是对先前收集数据的事后分析。在儿科重症监护病房（PICU）中，分析ALI后最初72小时内以每天每千克毫升数计算的累积液体平衡。主要结局是死亡率；次要结局是无呼吸机天数。结果。正液体平衡（以每24小时10毫升/千克的增量）与死亡率显著增加以及机械通气时间延长相关，与多器官系统衰竭的存在和氧合缺陷程度无关。当排除感染性休克患者亚组（n = 39）时，这些关系保持不变。结论。持续的正液体平衡可能对ALI儿科患者有害。有必要对ALI儿科患者的液体管理进行一项验证性的前瞻性随机对照试验。
