Association of Fluid Overload with Mortality in Critically-ill Mechanically Ventilated Children

Abstract

Objectives: To study the association of fluid overload with mortality and morbidity in critically-ill mechanically ventilated children. Design: Prospective observational study. Setting: Pediatric Intensive Care Unit (PICU) of a tertiary care hospital, New Delhi, India. Participants: 118 children (age 1 mo - 15 y) requiring mechanical ventilation. Outcome measures: Primary: Association of fluid overload with mortality. Secondary: Association of fluid overload with oxygenation, organ dysfunction, duration of mechanical ventilation and PICU stay. Results: Cumulative fluid overload of ≥15% was observed in 74 (62.7%) children. About 50% of these children reached cumulative fluid overload of ≥15% within the first 5 days of PICU stay. The mortality was 40.5% in those with ≥15% cumulative fluid compared to 34% in the rest [OR (95% CI): 1.02 (0.97, 1.07)]. On multivariate analysis, after adjusting for confounders, cumulative fluid overload ≥15% was associated with higher maximum PELOD (pediatric logistic organ dysfunction) score (Median: 21 vs. 12; P = 0.03), longer median duration of mechanical ventilation (10 vs. 4 d; P <0.0001) and PICU stay (13.5 vs. 6 d; P <0.0001). There was no significant association of fluid overload with oxygenation index (P=0.32). Conclusion: There is no association of fluid overload with mortality. However, it is associated with poor organ function, longer duration of mechanical ventilation and PICU stay in critically-ill, mechanically ventilated children.