Ingelse Sarah A, Wiegers Hanke M G, Calis Job C, van Woensel Job B, Bem Reinout A
All authors: Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Pediatr Crit Care Med. 2017 Mar;18(3):e106-e111. doi: 10.1097/PCC.0000000000001060.
Viral-lower respiratory tract disease is common in young children worldwide and is associated with high morbidity. Acute respiratory failure due to viral-lower respiratory tract disease necessitates PICU admission for mechanical ventilation. In critically ill patients in PICU settings, early fluid overload is common and associated with adverse outcomes such as prolonged mechanical ventilation and increased mortality. It is unclear, however, if this also applies to young children with viral-lower respiratory tract disease induced acute respiratory failure. In this study, we aimed to investigate the relation of early fluid overload with adverse outcomes in mechanically ventilated children with viral-lower respiratory tract disease in a retrospective dataset.
Retrospective cohort study.
Single, tertiary referral PICU.
One hundred thirty-five children (< 2 yr old) with viral-lower respiratory tract disease requiring mechanical ventilation admitted to the PICU of the Academic Medical Center, Amsterdam between 2008 and 2014.
None.
The cumulative fluid balance on day 3 of mechanical ventilation was compared against duration of mechanical ventilation (primary outcome) and daily mean oxygen saturation index (secondary outcome), using uni- and multivariable linear regression. In 132 children, the mean cumulative fluid balance on day 3 was + 97.9 (49.2) mL/kg. Higher cumulative fluid balance on day 3 was associated with a longer duration of mechanical ventilation in multivariable linear regression (β = 0.166; p = 0.048). No association was found between the fluid status and oxygen saturation index during the period of mechanical ventilation.
Early fluid overload is an independent predictor of prolonged mechanical ventilation in young children with viral-lower respiratory tract disease. This study suggests that avoiding early fluid overload is a potential target to reduce duration of mechanical ventilation in these children. Prospective testing in a clinical trial is warranted to support this hypothesis.
病毒性下呼吸道疾病在全球幼儿中很常见，且发病率很高。病毒性下呼吸道疾病导致的急性呼吸衰竭需要入住儿科重症监护病房（PICU）进行机械通气。在PICU的重症患者中，早期液体超负荷很常见，并与诸如机械通气时间延长和死亡率增加等不良后果相关。然而，这是否也适用于患有病毒性下呼吸道疾病导致急性呼吸衰竭的幼儿尚不清楚。在本研究中，我们旨在通过回顾性数据集调查早期液体超负荷与患有病毒性下呼吸道疾病的机械通气儿童不良后果之间的关系。
回顾性队列研究。
单一的三级转诊PICU。
2008年至2014年间入住阿姆斯特丹学术医疗中心PICU的135名患有病毒性下呼吸道疾病需要机械通气的儿童（<2岁）。
无。
使用单变量和多变量线性回归，将机械通气第3天的累计液体平衡与机械通气时间（主要结局）和每日平均氧饱和度指数（次要结局）进行比较。在132名儿童中，第3天的平均累计液体平衡为+97.9（49.2）mL/kg。在多变量线性回归中，第3天较高的累计液体平衡与机械通气时间延长相关（β = 0.166；p = 0.048）。在机械通气期间，未发现液体状态与氧饱和度指数之间存在关联。
早期液体超负荷是患有病毒性下呼吸道疾病的幼儿机械通气时间延长的独立预测因素。本研究表明，避免早期液体超负荷是减少这些儿童机械通气时间的一个潜在目标。有必要在临床试验中进行前瞻性测试以支持这一假设。
