Sumbel Lydia, Wats Aanchal, Salameh Mohammed, Appachi Elumalai, Bhalala Utpal
Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, TX, United States.
Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
Front Pediatr. 2021 Feb 25;8:564902. doi: 10.3389/fped.2020.564902. eCollection 2020.
Conventional methods of fluid assessment in critically ill children are difficult and/or inaccurate. Impedance cardiography has capability of measuring thoracic fluid content (TFC). There is an insufficient literature reporting correlation between TFC and conventional methods of fluid balance and whether TFC predicts outcomes in critically ill children. We hypothesized that TFC correlates with indices of fluid balance [FIMO (Fluid Intake Minus Output) and AFIMO (Adjusted Fluid Intake Minus Output)] and is a predictor of outcomes in critically ill children. Retrospective chart review. Pediatric intensive care unit of a tertiary care teaching hospital. Children <21 years, admitted to our Pediatric Intensive Care Unit (PICU) between July- November 2018 with acute respiratory failure and/or shock and who were monitored for fluid status using ICON® monitor. None. We collected demographic information, data on daily and cumulative fluid balance (CFB), ventilator, PICU and hospital days, occurrence of multi-organ dysfunction syndrome (MODS), and mortality. We calculated AFIMO using insensible fluid loss. We analyzed data using correlation coefficient, chi-square test and multiple linear regression analysis. We analyzed a total 327 recordings of TFC, FIMO and AFIMO as daily records of fluid balance in 61 critically ill children during the study period. The initial TFC, FIMO, and AFIMO in ml [median (IQR)] were 30(23, 44), 300(268, 325), and 21.05(-171.3, 240.2), respectively. The peak TFC, FIMO, and AFIMO in ml were 36(26, 24), 322(286, 334), and 108.8(-143.6, 324.4) respectively. The initial CFB was 1134.2(325.6, 2774.4). TFC did not correlate well with FIMO or AFIMO (correlation coefficient of 0.02 and -0.03, respectively), but a significant proportion of patients with high TFC exhibited pulmonary plethora on x-ray chest (as defined by increased bronchovascular markings and/or presence of pleural effusion) ( = 0.015). The multiple linear regression analysis revealed that initial and peak TFC and peak and mean FIMO and AFIMO predicted outcomes (ventilator days, length of PICU, and hospital days) in critically ill children ( < 0.05). In our cohort of critically ill children with respiratory failure and/or shock, TFC did not correlate with conventional measures of fluid balance (FIMO/AFIMO), but a significant proportion of patients with high TFC had pulmonary plethora on chest x-ray. Both initial and peak TFC predicted outcomes in critically ill children.
评估危重症患儿液体状况的传统方法存在困难且/或不准确。阻抗心动图能够测量胸腔内液体含量（TFC）。目前关于TFC与传统液体平衡方法之间的相关性以及TFC能否预测危重症患儿预后的文献报道不足。我们假设TFC与液体平衡指标[FIMO（液体摄入量减去排出量）和AFIMO（调整后的液体摄入量减去排出量）]相关，并且是危重症患儿预后的一个预测指标。回顾性病历审查。一家三级护理教学医院的儿科重症监护病房。年龄小于21岁，于2018年7月至11月因急性呼吸衰竭和/或休克入住我们儿科重症监护病房（PICU）且使用ICON®监护仪监测液体状态的患儿。无。我们收集了人口统计学信息、每日和累积液体平衡（CFB）数据、呼吸机使用情况、PICU住院天数和住院天数、多器官功能障碍综合征（MODS）的发生情况以及死亡率。我们使用不显性失液量计算AFIMO。我们采用相关系数、卡方检验和多元线性回归分析对数据进行分析。在研究期间，我们共分析了61例危重症患儿作为液体平衡每日记录的327份TFC、FIMO和AFIMO记录。初始TFC、FIMO和AFIMO的毫升数[中位数（四分位间距）]分别为30（23，44）、300（268，325）和21.05（-171.3，240.2）。TFC、FIMO和AFIMO的峰值毫升数分别为36（26，24）、322（286，334）和108.8（-143.6，324.4）。初始CFB为1134.2（325.6，2774.4）。TFC与FIMO或AFIMO的相关性不佳（相关系数分别为0.02和-0.03），但TFC较高的患者中有很大比例在胸部X线检查时表现为肺血增多（定义为支气管血管纹理增多和/或存在胸腔积液）（P = 0.015）。多元线性回归分析显示，初始和峰值TFC以及峰值和平均FIMO和AFIMO可预测危重症患儿的预后（呼吸机使用天数、PICU住院时长和住院天数）（P < 0.05）。在我们这组患有呼吸衰竭和/或休克的危重症患儿中，TFC与传统的液体平衡测量指标（FIMO/AFIMO）不相关，但TFC较高的患者中有很大比例在胸部X线检查时有肺血增多表现。初始和峰值TFC均可预测危重症患儿的预后。
