Vidal Solange, Pérez Augusto, Eulmesekian Pablo
Servicio de Terapia Intensiva Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina.
Arch Argent Pediatr. 2016 Aug 1;114(4):313-8. doi: 10.5546/aap.2016.eng.313. Epub 2016 Jun 23.
Associations between cumulative fluid balance and a prolonged duration of assisted mechanical ventilation have been described in adults. The aim of this study was to evaluate whether fluid balance in the first 48 hours of assisted mechanical ventilation initiation was associated with a prolonged duration of this process among children in the Pediatric Intensive Care Unit (PICU).
Retrospective cohort of patients in the PICU o, Hospital Italiano de Buenos Aires, between 1/1/2010 and 6/30/2012. Balance was calculated in percentage of body weight; prolonged mechanical ventilation was defined as >7 days, and confounders were registered. Univariate and multivariate analyses were performed.
Two hundred and forty-nine patients were mechanically ventilated for over 48 hours; 163 were included in the study. Balance during the first 48 hours of mechanical ventilation was 5.7% ± 5.86; 82 patients (50.3%) were on mechanical ventilation for more than 7 days. Age 〈 4 years old (OR 3.21, 95% CI 1.38-7.48, p 0.007), respiratory disease (OR 4.94, 95% CI 1.51-16.10, p 0.008), septic shock (OR 4.66, 95% CI 1.10-19.65, p 0.036), Pediatric Logistic Organ Dysfunction (PELOD) 〉 10 (OR 2.44, 95% CI 1.234.85, p 0.011), and positive balance 〉 13% (OR 4.02, 95% CI 1.08-15.02, p 0.038) were associated with prolonged mechanical ventilation. The multivariate model resulted in an OR 2.58, 95% CI: 1.17-5.58, p= 0.018 for PELOD 〉 10, and an OR 3.7, 95% CI: 0.91-14.94, p= 0.066 for positive balance 〉 13%.
Regarding prolonged mechanical ventilation, the multivariate model showed an independent association with organ dysfunction (PELOD 〉 10) and a trend towards an association with positive balance 〉 13%.
成人中已描述了累积液体平衡与机械通气辅助时间延长之间的关联。本研究的目的是评估在儿科重症监护病房（PICU）中，儿童机械通气辅助开始后最初48小时内的液体平衡是否与该过程的时间延长相关。
对布宜诺斯艾利斯意大利医院PICU在2010年1月1日至2012年6月30日期间的患者进行回顾性队列研究。以体重百分比计算平衡；将机械通气时间延长定义为>7天，并记录混杂因素。进行单因素和多因素分析。
249例患者接受机械通气超过48小时；163例纳入研究。机械通气最初48小时内的平衡为5.7%±5.86；82例患者（50.3%）机械通气时间超过7天。年龄<4岁（比值比3.21，95%置信区间1.38 - 7.48，p = 0.007）、呼吸系统疾病（比值比4.94，95%置信区间1.51 - 16.10，p = 0.008）、感染性休克（比值比4.66，95%置信区间1.10 - 19.65，p = 0.036）、小儿逻辑器官功能障碍（PELOD）>10（比值比2.44，95%置信区间1.23 - 4.85，p = 0.011）以及正平衡>13%（比值比4.02，95%置信区间1.08 - 15.02，p = 0.038）与机械通气时间延长相关。多因素模型显示，PELOD>10时比值比为2.58，95%置信区间：1.17 - 5.58，p = 0.018；正平衡>13%时比值比为3.7，95%置信区间：0.91 - 14.94，p = 0.066。
关于机械通气时间延长，多因素模型显示与器官功能障碍（PELOD>10）存在独立关联，并且与正平衡>13%存在关联趋势。
