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Intensive Care Medicine

, Volume 41, Issue 8, pp 1445–1453 | Cite as

Early fluid accumulation in children with shock and ICU mortality: a matched case–control study

  • Priya Bhaskar
  • Archana V. Dhar
  • Marita Thompson
  • Raymond Quigley
  • Vinai ModemEmail author
Original

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.

Keywords

Fluid overload Early fluid accumulation Mortality Children Shock 

Notes

Conflicts of interest

None of the authors have any conflicts of interest or financial disclosures to report. The study was funded by Internal Departmental Funds, Department of Pediatrics at the University of Texas Southwestern Medical School.

Supplementary material

134_2015_3851_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31.2 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Priya Bhaskar
    • 1
  • Archana V. Dhar
    • 2
  • Marita Thompson
    • 3
  • Raymond Quigley
    • 2
  • Vinai Modem
    • 2
    Email author
  1. 1.Cardiac Intensive Care Unit, Department of Pediatrics, Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of ChicagoNorthwestern UniversityChicagoUSA
  2. 2.Division of Critical Care Medicine, Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Mercy HospitalUniversity of Missouri–Kansas City School of MedicineKansas CityUSA

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