Matthew F Barhight1,2, Jennifer Lusk1, John Brinton3, Timothy Stidham1,2, Danielle E Soranno2,4,5, Sarah Faubel4,5, Jens Goebel2,4, Peter M Mourani1,2, Katja M Gist6,7,8. 1. Division of Critical Care, Children's Hospital Colorado, Aurora, CO, USA. 2. Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 3. Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 4. Division of Nephrology, Children's Hospital Colorado, Aurora, CO, USA. 5. Division of Renal Disease and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 6. Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. katja.gist@childrenscolorado.org. 7. Division of Cardiology, Children's Hospital Colorado, Aurora, CO, USA. katja.gist@childrenscolorado.org. 8. The Heart Institute, Children's Hospital Colorado, 13123 E. 16th Ave, Box 100, Aurora, CO, 80045-2535, USA. katja.gist@childrenscolorado.org.
Abstract
BACKGROUND: The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes. METHODS: This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy. RESULTS: Patients (n = 66) were dichotomized into two groups (peak chloride (Cl) ≥ 110 mmol/L vs. peak Cl < 110 mmol/L prior to CRRT initiation). Hyperchloremia was present in 39 (59%) children. Baseline characteristics were similar between groups. Fluid overload at CRRT initiation was more common in patients with hyperchloremia (11.5% IQR 3.8-22.4) compared to those without (5.5% IQR 0.9-13.9) (p = 0.04). Mortality was significantly higher in patients with hyperchloremia (n = 26, 67%) compared to those without (n = 8, 29%) (p = 0.006). Patients with hyperchloremia had 10.9 times greater odds of death compared to those without hyperchloremia, after adjusting for percent fluid overload, PRISM III score, time to initiation of CRRT, height, and weight (95% CI 2.4 to 49.5, p = 0.002). CONCLUSIONS: Hyperchloremia is common among critically ill children prior to CRRT initiation. In this population, hyperchloremia is independently associated with mortality. Further studies are needed to determine the impact of hyperchloremia on all critically ill children and the impact of chloride load on outcomes.
BACKGROUND: The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes. METHODS: This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy. RESULTS:Patients (n = 66) were dichotomized into two groups (peak chloride (Cl) ≥ 110 mmol/L vs. peak Cl < 110 mmol/L prior to CRRT initiation). Hyperchloremia was present in 39 (59%) children. Baseline characteristics were similar between groups. Fluid overload at CRRT initiation was more common in patients with hyperchloremia (11.5% IQR 3.8-22.4) compared to those without (5.5% IQR 0.9-13.9) (p = 0.04). Mortality was significantly higher in patients with hyperchloremia (n = 26, 67%) compared to those without (n = 8, 29%) (p = 0.006). Patients with hyperchloremia had 10.9 times greater odds of death compared to those without hyperchloremia, after adjusting for percent fluid overload, PRISM III score, time to initiation of CRRT, height, and weight (95% CI 2.4 to 49.5, p = 0.002). CONCLUSIONS: Hyperchloremia is common among critically ill children prior to CRRT initiation. In this population, hyperchloremia is independently associated with mortality. Further studies are needed to determine the impact of hyperchloremia on all critically ill children and the impact of chloride load on outcomes.
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Authors: Matthew F Barhight; John Brinton; Timothy Stidham; Danielle E Soranno; Sarah Faubel; Benjamin R Griffin; Jens Goebel; Peter M Mourani; Katja M Gist Journal: Intensive Care Med Date: 2018-10-31 Impact factor: 17.440
Authors: Adrian F Bulfon; Hakem L Alomani; Natalie Anton; Brooke T Comrie; Bram Rochwerg; Sorina A Stef; Lehana Thabane; Thuva Vanniyasingam; Karen Choong Journal: J Pediatr Intensive Care Date: 2019-06-19