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Positive Fluid Balance is Associated with Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock.
Ann Acad Med Singap. 2019 Sep; 48(9):290-297.AA

Abstract

INTRODUCTION

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.

MATERIALS AND METHODS

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.

RESULTS

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]%; P <0.001). Cumulative %FO was associated with increased mortality (adjusted odds ratio 1.08, 95% confidence interval 1.03-1.13; P = 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).

CONCLUSION

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.

Authors+Show Affiliations

Children's Intensive Care Unit, Department of Paediatric Subspecialities, KK Women's and Children's Hospital, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31737894

Citation

Wong, Judith Jm, et al. "Positive Fluid Balance Is Associated With Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock." Annals of the Academy of Medicine, Singapore, vol. 48, no. 9, 2019, pp. 290-297.
Wong JJ, Ho SX, Lee AOC, et al. Positive Fluid Balance is Associated with Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock. Ann Acad Med Singap. 2019;48(9):290-297.
Wong, J. J., Ho, S. X., Lee, A. O. C., Sultana, R., Chong, S. L., Mok, Y. H., Chan, Y. H., & Lee, J. H. (2019). Positive Fluid Balance is Associated with Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock. Annals of the Academy of Medicine, Singapore, 48(9), 290-297.
Wong JJ, et al. Positive Fluid Balance Is Associated With Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock. Ann Acad Med Singap. 2019;48(9):290-297. PubMed PMID: 31737894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Positive Fluid Balance is Associated with Poor Clinical Outcomes in Paediatric Severe Sepsis and Septic Shock. AU - Wong,Judith Jm, AU - Ho,Stephanie X, AU - Lee,Alpha Omega Cj, AU - Sultana,Rehena, AU - Chong,Shu Ling, AU - Mok,Yee Hui, AU - Chan,Yoke Hwee, AU - Lee,Jan Hau, PY - 2019/11/19/entrez PY - 2019/11/19/pubmed PY - 2020/4/11/medline SP - 290 EP - 297 JF - Annals of the Academy of Medicine, Singapore JO - Ann Acad Med Singap VL - 48 IS - 9 N2 - INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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]%; P <0.001). Cumulative %FO was associated with increased mortality (adjusted odds ratio 1.08, 95% confidence interval 1.03-1.13; P = 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). CONCLUSION: 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. SN - 0304-4602 UR - https://www.unboundmedicine.com/medline/citation/31737894/Positive_Fluid_Balance_is_Associated_with_Poor_Clinical_Outcomes_in_Paediatric_Severe_Sepsis_and_Septic_Shock_ L2 - http://www.annals.edu.sg/pdf/48VolNo9Sep2019/V48N9p290.pdf DB - PRIME DP - Unbound Medicine ER -