Children's Intensive Care Unit, Department of Paediatric Subspecialities, KK Women's and Children's Hospital, Singapore.
Ann Acad Med Singap. 2019 Sep;48(9):290-297.
Growing evidence suggests there is potential harm associated with excess fluid in critically ill children. This study aimed to evaluate the association between percentage fluid overload (%FO) and paediatric intensive care unit (PICU) mortality in children with severe sepsis and septic shock.
Patients with severe sepsis and septic shock admitted to the PICU were identified through discharge codes. Data on clinical characteristics, fluid input and output were collected. %FO was calculated as: (total daily input - total daily output [L]/admission body weight [kg]) × 100. The primary outcome was PICU mortality. Secondary outcomes were 28-day ventilator-free days (VFD), intensive care unit-free days (IFD) and inotrope-free days (InoFD). Multivariate analysis adjusting for presence of comorbidities, Pediatric Index of Mortality (PIM) 2 score and multiorgan dysfunction were used to determine the association between cumulative %FO over 5 days and outcomes.
A total of 116 patients were identified, with a mortality rate of 28.4% (33/116). Overall median age was 105.9 (23.1-157.2) months. Cumulative %FO over 5 days was higher in non-survivors compared to survivors (median [interquartile range], 15.1 [6.3-27.1] vs 3.6 [0.7-11.1]%; <0.001). Cumulative %FO was associated with increased mortality (adjusted odds ratio 1.08, 95% confidence interval 1.03-1.13; = 0.001) and decreased VFD, IFD and InoFD (adjusted mean difference -0.37 [-0.53 - -0.21] days, -0.34 [-0.49 - -0.20] days, and -0.31 [-0.48 - -0.14] days, respectively).
Cumulative %FO within the first 5 days of PICU stay was consistently and independently associated with poor clinical outcomes in children with severe sepsis and septic shock. Future studies are needed to test the impact of restrictive fluid strategies in these children.
越来越多的证据表明，危重症患儿体内液体过多可能存在潜在危害。本研究旨在评估严重脓毒症和脓毒性休克患儿的液体超负荷百分比（%FO）与儿科重症监护病房（PICU）死亡率之间的关系。
通过出院代码确定入住 PICU 的严重脓毒症和脓毒性休克患儿。收集临床特征、液体输入和输出的数据。%FO 的计算方法为：（每日总入量-每日总出量[L]/入院体重[kg]）×100。主要结局为 PICU 死亡率。次要结局为 28 天无呼吸机天数（VFD）、无 ICU 天数（IFD）和无血管加压素天数（InoFD）。使用多变量分析调整共存疾病、儿科死亡率 2 评分和多器官功能障碍的存在，以确定 5 天内累积%FO 与结局之间的关系。
共确定 116 例患儿，死亡率为 28.4%（33/116）。总体中位年龄为 105.9（23.1-157.2）个月。与存活者相比，非存活者的累积 5 天%FO 更高（中位数[四分位距]，15.1[6.3-27.1] vs 3.6[0.7-11.1]%；<0.001）。累积%FO 与死亡率增加相关（调整后的优势比 1.08，95%置信区间 1.03-1.13；=0.001），且 VFD、IFD 和 InoFD 减少（调整后的平均差异-0.37[-0.53- -0.21]天，-0.34[-0.49- -0.20]天，-0.31[-0.48- -0.14]天）。
入住 PICU 后前 5 天内的累积%FO 与严重脓毒症和脓毒性休克患儿的临床结局不良始终且独立相关。需要进一步研究来检验在这些患儿中实施限制液体策略的影响。
