Priya Bhaskar1, Archana V Dhar, Marita Thompson, Raymond Quigley, Vinai Modem. 1. Cardiac Intensive Care Unit, Department of Pediatrics, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, 225 East Chicago Avenue, Box 21, Chicago, IL, USA.
Abstract
PURPOSE: The purpose of this study was to evaluate the association between early fluid accumulation and mortality in children with shock states. METHODS: We retrospectively reviewed children admitted in shock states to the pediatric intensive care unit (ICU) at a tertiary level children's hospital over a 7-month period. The study was designed as a matched case-control study. Children with early fluid overload, defined as fluid accumulation of ≥10% of admission body weight during the initial 3 days, were designated as the cases. They were compared with matched controls without early fluid accumulation. Cases and controls were matched for age, severity of illness at ICU admission and need for organ support. They were compared with respect to all-cause ICU mortality and other secondary outcomes. RESULTS: A total of 114 children (age range 0-17.4 years; N = 42 cases and 72 matched controls) met the study criteria. Mortality rate was 13% (15/114) in this cohort. Multivariable logistic regression analysis identified the presence of early fluid overload [adjusted odds ratio (OR) 9.17, 95% confidence interval (CI) 2.22-55.57], its severity (adjusted OR 1.11, 95% CI 1.05-1.19) and its duration (adjusted OR 1.61, 95% CI 1.21-2.28) as independent predictors of mortality. Cases had higher mortality than the controls (26 vs. 6 %; p 0.003), and this difference remained significant in the matched analysis (37 vs. 3%; p 0.002). CONCLUSION: The presence, severity and duration of early fluid are associated with increased ICU mortality in children admitted to the pediatric ICU in shock states.
PURPOSE: The purpose of this study was to evaluate the association between early fluid accumulation and mortality in children with shock states. METHODS: We retrospectively reviewed children admitted in shock states to the pediatric intensive care unit (ICU) at a tertiary level children's hospital over a 7-month period. The study was designed as a matched case-control study. Children with early fluid overload, defined as fluid accumulation of ≥10% of admission body weight during the initial 3 days, were designated as the cases. They were compared with matched controls without early fluid accumulation. Cases and controls were matched for age, severity of illness at ICU admission and need for organ support. They were compared with respect to all-cause ICU mortality and other secondary outcomes. RESULTS: A total of 114 children (age range 0-17.4 years; N = 42 cases and 72 matched controls) met the study criteria. Mortality rate was 13% (15/114) in this cohort. Multivariable logistic regression analysis identified the presence of early fluid overload [adjusted odds ratio (OR) 9.17, 95% confidence interval (CI) 2.22-55.57], its severity (adjusted OR 1.11, 95% CI 1.05-1.19) and its duration (adjusted OR 1.61, 95% CI 1.21-2.28) as independent predictors of mortality. Cases had higher mortality than the controls (26 vs. 6 %; p 0.003), and this difference remained significant in the matched analysis (37 vs. 3%; p 0.002). CONCLUSION: The presence, severity and duration of early fluid are associated with increased ICU mortality in children admitted to the pediatric ICU in shock states.
Authors: Christian Torgersen; Martin W Dünser; Christian A Schmittinger; Ville Pettilä; Esko Ruokonen; Volker Wenzel; Stephan M Jakob; Jukka Takala Journal: Eur J Anaesthesiol Date: 2011-04 Impact factor: 4.330
Authors: Herbert P Wiedemann; Arthur P Wheeler; Gordon R Bernard; B Taylor Thompson; Douglas Hayden; Ben deBoisblanc; Alfred F Connors; R Duncan Hite; Andrea L Harabin Journal: N Engl J Med Date: 2006-05-21 Impact factor: 91.245
Authors: Stacey L Valentine; Anil Sapru; Renee A Higgerson; Phillip C Spinella; Heidi R Flori; Dionne A Graham; Molly Brett; Maureen Convery; LeeAnn M Christie; Laurie Karamessinis; Adrienne G Randolph Journal: Crit Care Med Date: 2012-10 Impact factor: 7.598
Authors: Kamal Abulebda; Natalie Z Cvijanovich; Neal J Thomas; Geoffrey L Allen; Nick Anas; Michael T Bigham; Mark Hall; Robert J Freishtat; Anita Sen; Keith Meyer; Paul A Checchia; Thomas P Shanley; Jeffrey Nowak; Michael Quasney; Scott L Weiss; Arun Chopra; Sharon Banschbach; Eileen Beckman; Christopher J Lindsell; Hector R Wong Journal: Crit Care Med Date: 2014-02 Impact factor: 7.598
Authors: Jonathan A Silversides; Emmet Major; Andrew J Ferguson; Emma E Mann; Daniel F McAuley; John C Marshall; Bronagh Blackwood; Eddy Fan Journal: Intensive Care Med Date: 2016-10-12 Impact factor: 17.440
Authors: David T Selewski; David J Askenazi; Brian C Bridges; David S Cooper; Geoffrey M Fleming; Matthew L Paden; Mark Verway; Rashmi Sahay; Eileen King; Michael Zappitelli Journal: Pediatr Crit Care Med Date: 2017-12 Impact factor: 3.624
Authors: David T Selewski; Ayse Akcan-Arikan; Elizabeth M Bonachea; Katja M Gist; Stuart L Goldstein; Mina Hanna; Catherine Joseph; John D Mahan; Arwa Nada; Amy T Nathan; Kimberly Reidy; Amy Staples; Pia Wintermark; Louis J Boohaker; Russell Griffin; David J Askenazi; Ronnie Guillet Journal: Pediatr Res Date: 2018-09-20 Impact factor: 3.756
Authors: Sarah A Ingelse; Roelie M Wösten-van Asperen; Joris Lemson; Joost G Daams; Reinout A Bem; Job B van Woensel Journal: Front Pediatr Date: 2016-03-21 Impact factor: 3.418