Gelbart Ben, Serpa Neto Ary, Stephens David, Thompson Jenny, Bellomo Rinaldo, Butt Warwick, Duke Trevor
Paediatric Intensive Care Unit, University of Melbourne, Department of Paediatrics, Department of Critical Care, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, VIC, Australia.
Pediatr Crit Care Med. 2022 Dec 1;23(12):990-998. doi: 10.1097/PCC.0000000000003047. Epub 2022 Sep 8.
To describe the prevalence, patterns, explanatory variables, and outcomes associated with fluid accumulation (FA) in mechanically ventilated children.
Retrospective cohort study.
Tertiary PICU.
Children mechanically ventilated for greater than or equal to 24 hours.
None.
Between July 2016 and July 2021, 1,636 children met eligibility criteria. Median age was 5.5 months (interquartile range [IQR], 0.7-46.5 mo), and congenital heart disease was the most common diagnosis. Overall, by day 7 of admission, the median maximum cumulative FA, as a percentage of estimated admission weight, was 7.5% (IQR, 3.3-15.1) occurring at a median of 4 days after admission. Overall, higher FA was associated with greater duration of mechanical ventilation (MV) (mean difference, 1.17 [95% CI, 1.13-1.22]; p < 0.001]), longer intensive care length of stay (LOS) (mean difference, 1.16 [95% CI, 1.12-1.21]; p < 0.001]), longer hospital LOS (mean difference, 1.19 [95% CI, 1.13-1.26]; p < 0.001]), and increased mortality (odds ratio, 1.31 [95% CI, 1.08-1.59]; p = 0.005). However, these associations depended on the effects of children with extreme values, and there was no increase in risk up to 20% FA, overall, in children following cardiopulmonary bypass and in children in the general ICU. When excluding children with maximum FA of >10%, there was no association with duration of MV (mean difference, 0.99 [95% CI, 0.94-1.04]; p = 0.64) and intensive care or hospital LOS (mean difference, 1.01 [95% CI, 0.96-1.06]; p = 0.70 and 1.01 [95% CI, 0.95-1.08]; 0.79, respectively) but an association with reduced mortality 0.71 (95% CI, 0.53-0.97; p = 0.03).
In mechanically ventilated critically ill children, greater maximum FA was associated with longer duration of MV, intensive care LOS, hospital LOS, and mortality. However, these findings were driven by extreme values of FA of greater than 20%, and up to 10%, there was reduced mortality and no signal of harm.
描述机械通气儿童液体蓄积（FA）的患病率、模式、解释变量及相关结局。
回顾性队列研究。
三级儿科重症监护病房。
机械通气时间≥24小时的儿童。
无。
2016年7月至2021年7月期间，1636名儿童符合纳入标准。中位年龄为5.5个月（四分位间距[IQR]，0.7 - 46.5个月），先天性心脏病是最常见的诊断。总体而言，至入院第7天，FA的最大累积量中位数（占预计入院体重的百分比）为7.5%（IQR，3.3 - 15.1），出现在入院后中位数4天。总体而言，较高的FA与机械通气（MV）时间延长相关（平均差值，1.17[95%CI，1.13 - 1.22]；p < 0.001）、重症监护病房住院时间（LOS）延长（平均差值，1.16[95%CI，1.12 - 1.21]；p < 0.001）、医院住院时间延长（平均差值，1.19[95%CI，1.13 - 1.26]；p < 0.001）以及死亡率增加（比值比，1.31[95%CI，1.08 - 1.59]；p = 0.005）。然而，这些关联取决于极值儿童的影响，总体而言，在接受体外循环的儿童和普通重症监护病房的儿童中，FA高达20%时风险并无增加。排除最大FA>10%的儿童后，与MV时间（平均差值，0.99[95%CI，0.94 - 1.04]；p = 0.64）、重症监护或医院LOS无关联（平均差值，1.01[95%CI，0.96 - 1.06]；p = 0.70以及1.01[95%CI，0.95 - 1.08]；0.79），但与死亡率降低相关（0.71[95%CI，0.53 - 0.97]；p = 0.03）。
在机械通气的危重症儿童中，较高的最大FA与MV时间延长、重症监护病房LOS、医院LOS及死亡率相关。然而，这些发现是由FA大于20%的极值驱动的，FA高达10%时，死亡率降低且无有害信号。
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