Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alberta and Stollery Children Children's Hospital, Edmonton, AB, Canada.
Department of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
Crit Care Med. 2020 Jul;48(7):1034-1041. doi: 10.1097/CCM.0000000000004376.
To describe the characteristics of fluid accumulation in critically ill children and evaluate the association between the degree, timing, duration, and rate of fluid accumulation and patient outcomes.
Retrospective cohort study.
PICUs in Alberta, Canada.
All children admitted to PICU in Alberta, Canada, between January 1, 2015, and December 31, 2015.
None.
A total of 1,017 patients were included. Fluid overload % increased from median (interquartile range) 1.58% (0.23-3.56%; n = 1,017) on day 1 to 16.42% (7.53-27.34%; n = 111) on day 10 among those remaining in PICU. The proportion of patients (95% CI) with peak fluid overload % greater than 10% and greater than 20% was 32.7% (29.8-35.7%) and 9.1% (7.4-11.1%), respectively. Thirty-two children died (3.1%) in PICU. Peak fluid overload % was associated with greater PICU mortality (odds ratio, 1.05; 95% CI, 1.02-1.09; p = 0.001). Greater peak fluid overload % was associated with Major Adverse Kidney Events within 30 days (odds ratio, 1.05; 95% CI, 1.02-1.08; p = 0.001), length of mechanical ventilation (B coefficient, 0.66; 95% CI, 0.54-0.77; p < 0.001), and length of PICU stay (B coefficient, 0.52; 95% CI, 0.46-0.58; p < 0.001). The rate of fluid accumulation was associated with PICU mortality (odds ratio, 1.15; 95% CI, 1.01-1.31; p = 0.04), Major Adverse Kidney Events within 30 days (odds ratio, 1.16; 95% CI, 1.03-1.30; p = 0.02), length of mechanical ventilation (B coefficient, 0.80; 95% CI, 0.24-1.36; p = 0.005), and length of PICU stay (B coefficient, 0.38; 95% CI, 0.11-0.66; p = 0.007).
Fluid accumulation occurs commonly during PICU course and is associated with considerable mortality and morbidity. These findings highlight the need for the development and evaluation of interventional strategies to mitigate the potential harm associated with fluid accumulation.
描述危重症患儿液体蓄积的特征，并评估液体蓄积的程度、时间、持续时间和速率与患者结局的相关性。
回顾性队列研究。
加拿大艾伯塔省的 PICU。
2015 年 1 月 1 日至 2015 年 12 月 31 日期间在加拿大艾伯塔省 PICU 住院的所有患儿。
无。
共纳入 1017 例患儿。在仍留在 PICU 的患儿中，第 1 天液体超负荷%中位数（四分位距）为 1.58%（0.23-3.56%；n=1017），第 10 天增加至 16.42%（7.53-27.34%；n=111）。液体超负荷%峰值大于 10%和大于 20%的患儿比例分别为 32.7%（29.8-35.7%）和 9.1%（7.4-11.1%）。32 例患儿在 PICU 死亡（3.1%）。液体超负荷%峰值与更高的 PICU 死亡率相关（比值比，1.05；95%置信区间，1.02-1.09；p=0.001）。更高的液体超负荷%峰值与 30 天内的主要不良肾脏事件（比值比，1.05；95%置信区间，1.02-1.08；p=0.001）、机械通气时间（B 系数，0.66；95%置信区间，0.54-0.77；p<0.001）和 PICU 住院时间（B 系数，0.52；95%置信区间，0.46-0.58；p<0.001）相关。液体蓄积速率与 PICU 死亡率（比值比，1.15；95%置信区间，1.01-1.31；p=0.04）、30 天内的主要不良肾脏事件（比值比，1.16；95%置信区间，1.03-1.30；p=0.02）、机械通气时间（B 系数，0.80；95%置信区间，0.24-1.36；p=0.005）和 PICU 住院时间（B 系数，0.38；95%置信区间，0.11-0.66；p=0.007）相关。
液体蓄积在 PICU 病程中很常见，与较高的死亡率和发病率有关。这些发现强调需要开发和评估干预策略，以减轻与液体蓄积相关的潜在危害。
